The Derm Resident: Boards Fodder and Clinical Pearls for Dermatology Residents

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Irritant Contact Dermatitis & Eczema Variants: Occupational Dermatoses, Poison Ivy, and Key Board Pearls | The Derm Resident

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Hosts Dr. Jonny Hatch and Dr. Deven Curtis review irritant contact dermatitis (ICD) versus allergic contact dermatitis (ACD), emphasizing ICD as non-immunologic, dose/time-dependent direct keratinocyte injury with barrier disruption and cytokine release, while ACD is a type IV delayed T-cell hypersensitivity requiring prior sensitization. They cover common irritants (wet work, soaps/detergents, solvents), clinical clues (immediate onset and burning/stinging for ICD vs 24–48 hour peak and intense pruritus for ACD), and acute caustic burns versus chronic cumulative disease. Management focuses on avoidance/protection, moisturizers, topical steroids (sometimes under occlusion), patch testing for allergens, and mention of Anzepko for chronic hand dermatitis; occupational risks include healthcare workers (including latex type I IgE reactions), hairdressers (PPD and other allergens), and construction workers (cement irritation and chromium allergy). They review toxicodendron (poison ivy/oak/sumac) dermatitis with linear vesicles/bullae from urushiol, non-contagious blister fluid, fomite spread, cross-reactivity (mango skin, cashew shell oil, ginkgo), and prolonged systemic steroid tapers for severe cases. They also summarize Compositae/Asteraceae airborne contact dermatitis and eczema variants including nummular, dyshidrotic/pompholyx, asteatotic/eczema craquelé, stasis dermatitis, id reaction, and hyperkeratotic hand dermatitis.

00:00 Welcome and Disclaimer
00:31 Eczema Origins and Roadmap
01:35 ICD vs ACD Basics
05:06 Cellular Mechanism
06:48 Common Irritants and Wet Work
08:21 Clues Timing Itch Burn
10:14 Acute vs Chronic ICD
12:33 Treatment and Moisturizers
17:55 High Yield Occupations
23:33 Patch Testing Role
24:53 Poison Ivy Basics
25:49 Poison Ivy Name Origins
26:49 Classic Rash Clues
28:11 Not Contagious Explained
31:03 Cross Reactivity Foods
34:06 Asteraceae Airborne Dermatitis
36:48 Treatment Wash Steroids
38:12 Eczema Variants Blitz
42:41 Stasis Dermatitis Pitfalls
44:53 Id Reaction Basics
46:36 Hyperkeratotic Hands Wrap

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Allergic Contact Dermatitis: Type IV Hypersensitivity, Patch Testing, and High-Yield Allergens | The Derm Resident

Dr. Jonny Hatch and Dr. Deven Curtis review allergic contact dermatitis (ACD) as a type IV, T-cell–mediated delayed hypersensitivity, contrasting it with the more common irritant contact dermatitis (ICD), which is non-immunologic and can occur on first exposure. They outline sensitization (hapten-protein complex processed by Langerhans cells in lymph nodes) and elicitation on re-exposure with cytokine-driven spongiotic dermatitis, pruritus, and possible vesicles. Clinical clues include delayed onset in ACD, burning/stinging and rapid onset in ICD, and using distribution patterns (earlobes, periumbilical, eyelids, shoes, scalp). They explain patch testing logistics, grading, pitfalls (irritant reactions, angry back syndrome, false negatives), and ROAT. High-yield allergens include nickel, fragrance mixes/balsam of Peru, formaldehyde releasers, rubber accelerators, neomycin, cobalt, PPD, MI, acrylates, urushiol, textile dyes, and chromates in cement. Management emphasizes allergen avoidance aided by CAMP/SkinSafe and topical/systemic steroids for flares, noting rebound with short steroid courses.

00:00 Allergic Contact Dermatitis Overview
01:27 Allergy History Pearl
02:24 Irritant vs Allergic Dermatitis
05:54 Type Four Immunology Basics
07:10 Sensitization and Elicitation
12:00 Clinical Morphology and Timing
12:53 Distribution Pattern Clues
14:59 Patch Testing When and Why
17:33 Patch Testing How It Works
19:41 Reading Results and Pitfalls
22:47 High Yield Allergens List
34:34 Special Scenarios and Occupations
39:32 Treatment and Allergen Avoidance
43:43 Wrap Up and Resources

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at https://mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Alopecia Boot Camp: Scarring vs Non-Scarring, Key Patterns, Dermoscopy Pearls, and First-Line Management | The Derm Resident

Contact: thedermresident.pod@gmail.com

Hosts Dr. Jonny Hatch and Dr. Deven Curtis present an “alopecia boot camp” framework focused on first distinguishing scarring (cicatricial) from non-scarring alopecia by assessing follicular ostia with dermoscopy, emphasizing that scarring implies permanent loss and requires urgent treatment at the active edge for biopsy and intralesional therapy. They review non-scarring causes including androgenetic alopecia (DHT-driven miniaturization, anisotrichosis; Hamilton-Norwood/Ludwig scales; minoxidil, finasteride/dutasteride, spironolactone in women, PRP and transplant with donor dominance), alopecia areata (CD8 attack, exclamation point hairs, yellow/black dots; ILK and FDA-approved JAK inhibitors baricitinib and ritlecitinib; totalis/universalis/ophiasis), telogen effluvium (delayed shedding after stressors; hair pull test; consider TSH and iron studies/ferritin), traction alopecia (fringe sign; may become scarring), and trichotillomania (broken hairs of varying length). Scarring alopecias covered include LPP/FFA (perifollicular erythema and tubular scale; hydroxychloroquine/doxycycline and steroids), CCCA (central centrifugal pattern; biopsy active border; discuss styling factors and PADI3), and rapid-fire pearls for DLE (follicular plugging), folliculitis decalvans (tufting; clindamycin/rifampin), dissecting cellulitis (boggy nodules/sinus tracts; follicular occlusion tetrad), and acne keloidalis nuchae (posterior scalp/neck plaques; consider laser/excision).

00:00 Alopecia Boot Camp
00:52 Why Hair Loss Is Hard
01:24 Scarring Versus Nonscarring
03:28 Follicular Ostia Clues
05:38 Androgenetic Alopecia Basics
08:05 Treating Pattern Hair Loss
08:34 Minoxidil ICU Story
12:08 Counseling and Transplants
13:44 Alopecia Areata Recognition
17:04 Areata Workup and Treatment
18:30 Telogen Effluvium Shift
20:31 Postpartum Shedding Explained
20:54 Hair Pull Test Basics
21:50 When to Order Labs
23:37 Traction Alopecia Red Flags
26:21 Trichotillomania Patterns
27:42 LPP and FFA Scarring Clues
30:09 Treating LPP and FFA Early
31:33 CCCA Diagnosis and Biopsy
36:04 Rapid Fire Scarring Alopecias
40:19 Clinic Safety Takeaways
41:12 Boot Camp Wrap Up

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at https://mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Hidradenitis Suppurativa (HS) Boot Camp: Diagnosis, Hurley Staging, Treatment Ladder & Surgical Options | The Derm Resident

Contact: thedermresident.pod@gmail.com

Dr. Jonny Hatch and Dr. Deven Curtis deliver a clinic-focused boot camp on hidradenitis suppurativa (HS), noting the misnomer (not a sweat-gland disease) and reviewing typical intertriginous involvement with painful nodules/abscesses and the pathognomonic double-ended open comedone. They discuss delayed diagnosis, stigma, family history, modifiable factors (smoking and obesity), and flare triggers (menses, friction, sweating, heat, diet). Hurley staging is outlined (I boils only; II recurrent abscesses with sinus tracts/scars; III diffuse interconnected tracts) with emphasis that severity and inflammation may not perfectly match stage. They highlight disease burden (pain, depression screening; associations with Crohn disease, PCOS, metabolic syndrome), exam pearls, and a treatment ladder: topicals (clindamycin with BPO), oral antibiotics (doxycycline, clinda/rifampin; rescue options), hormonal therapy, biologics (adalimumab, infliximab, IL-17 agents), and procedures (I&D, punch deroofing, deroofing, wide excision, reconstruction), plus counseling that HS is chronic, not due to hygiene, and requires ongoing support.

00:00 HS Boot Camp Intro
00:30 Name Origins and Misnomer
02:06 Classic Presentation and Diagnosis
05:04 Risk Factors and Flare Triggers
07:09 Hurley Staging Basics
11:12 Disease Burden and Comorbidities
13:13 Topicals and Lifestyle First Line
15:20 Oral Antibiotics and Escalation
16:58 Hormonal Therapy Pearls
20:00 Biologics for Moderate Severe HS
24:20 Surgical Options and Deroofing
29:38 Patient Counseling and Wrap Up

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at https://mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Psoriasis Part 2: Differentials, Psoriatic Arthritis Screening, and the Psoriasis Treatment Ladder | The Derm Resident

Contact: thedermresident.pod@gmail.com

Hosts Dr. Jonny Hatch and Dr. Deven Curtis continue psoriasis with a focus on chronic plaque differentials, psoriatic arthritis, and a practical treatment ladder. They review mimickers including seborrheic dermatitis and lichen simplex chronicus (including “sebo-psoriasis”), mycosis fungoides prompting biopsy when plaques are treatment-resistant or atrophic, hypertrophic lichen planus on shins, and guttate-pattern differentials such as pityriasis rosea, pityriasis lichenoides chronica, and secondary syphilis. They emphasize screening for psoriatic arthritis (about one-third of patients; HLA-B27 association) using joint/back pain history, nail findings, and dactylitis, with rheumatology referral when appropriate. Treatments covered include topical steroids by site, calcipotriene, tazarotene, roflumilast foam, tapinarof, phototherapy (narrowband UVB preferred over PUVA), and systemic therapies (methotrexate with folate, cyclosporine, apremilast, acitretin) plus biologics (TNF, IL-17, IL-23, ustekinumab) and deucravacitinib, along with biologic prescreening (TB, hepatitis, CBC/CMP, vaccine counseling) and psoriasis comorbidity risks.

00:00 Show Intro and Disclaimer
00:29 Plaque Psoriasis Differentials
02:21 Guttate Mimickers
03:25 Screening for Psoriatic Arthritis
04:53 Topical Treatment Basics
06:32 Nonsteroid Topicals and New Agents
08:13 Phototherapy UVB and PUVA
10:45 Systemics Methotrexate Deep Dive
13:45 Cyclosporine and Oral Options
18:11 Biologics TNF Alpha Inhibitors
22:41 IL-17 Inhibitors Key Pearls
25:47 IL-23 and IL-12/23 Therapies
28:23 Deucravacitinib and Biologic Workup
30:46 Psoriasis as Systemic Disease
31:32 Closing Pearls and Wrap Up

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at https://mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Psoriasis High-Yield Review (Part 1): Epidemiology, Immunopathogenesis, Triggers, and Clinical Variants | The Derm Resident

Hosts Dr. Jonny Hatch and Dr. Deven Curtis review psoriasis for residents, covering historical confusion with leprosy, prevalence (about 2% worldwide; higher in the US/Canada), bimodal onset (20–30 and 50–60), and systemic burden including psoriatic arthritis and comorbid metabolic, cardiovascular, and mood disease. They discuss genetics (notably HLA-Cw6 at PSORS1) and modern immunopathogenesis centered on the IL-23/Th17/IL-17 axis, including keratinocyte–immune “vicious cycle,” neutrophilic histology (Munro microabscesses, spongiform pustules of Kogoj), and TNF’s broad role. The episode reviews disease memory, Koebner phenomenon, triggers (strep, stress, HIV, hypocalcemia, pregnancy, key medications), lifestyle associations, classic plaque features and signs (Auspitz, Woronoff), PASI scoring, and variants including guttate, erythrodermic, and pustular psoriasis (IL36RN/DITRA; spesolimab), plus scalp, inverse, nail, and rare mucosal involvement.

Contact: thedermresident.pod@gmail.com

00:00 Show Intro and Disclaimer
00:36 Psoriasis History Origins
02:06 Epidemiology and Onset
03:23 Systemic Burden Comorbidities
04:22 Genetics and HLA CW6
06:38 Modern Immune Model
08:43 Trigger to T Cell Cascade
12:02 Th17 Cytokines and Plaques
15:08 IL 23 Th17 Axis Explained
18:20 Histology Neutrophils and TNF
20:48 Disease Memory and Koebner
22:36 Triggers Infections Drugs Lifestyle
27:19 Plaque Psoriasis Clinical Exam
30:10 PASI Score Made Simple
32:37 Guttate and Erythrodermic Types
35:40 Pustular Variants and Genetics
40:11 Special Sites Nails Mucosa
42:14 Wrap Up and Part Two

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at https://mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Chronic Pruritus Workup & Treatment Pearls (CPUO, Neuropathic Itch, Nemolizumab, JAKs) | The Derm Resident

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Dr. Jonny Hatch hosts Dr. Diego Da Silva, a chronic pruritus expert and host of Skin In the Game, to discuss a practical approach to itch. They outline an initial framework based on distribution (localized vs generalized), time course (with shorter duration and older age raising concern for malignancy), and morphology (primary lesions vs excoriations only). For localized itch without rash, they emphasize neuropathic etiologies (notalgia paresthetica, brachioradial pruritus, meralgia, dysesthesias), consider spine wear-and-tear, and discuss PT plus gabapentinoids and other neuromodulators. For generalized pruritus without rash, they review ROS for constitutional symptoms, recommend considering biopsy of “normal” itchy skin (e.g., CTCL, sarcoid), and suggest labs (CBC, CMP, TSH, A1C, SPEP/IFE, ferritin, vitamin D), chest X-ray, and BP testing/DIF. Treatment pearls include skincare, phototherapy, atopic-directed therapies (dupilumab, nemolizumab), JAK inhibitor counseling (noting shingles risk and “JAKne”), and empiric ivermectin for possible scabies; off-label options include low-dose naltrexone, dronabinol, and intranasal butorphanol, plus advice for residents to develop a niche and “declare” expertise.

00:00 Show Introduction
00:59 Why Itch Matters
01:26 Finding a Niche
04:44 First Steps in Pruritus
07:00 Localized Itch Workup
09:02 Neuropathic Itch Treatments
11:32 Generalized Itch Workup
14:32 Labs Imaging and Biopsy
17:54 Treating CPUO Like Atopy
21:49 Choosing First Biologic
22:27 Nemolizumab Itch Breakthrough
23:58 JAK Inhibitors Safety Reality
26:08 Managing Shingles And Jackne
28:05 Treating Jackne Options
28:54 Derms As Real Doctors
30:54 Low Dose Naltrexone Role
32:15 Scabies And Empiric Ivermectin
33:09 Off Label Itch Rescue Meds
35:42 Advice And Podcast Wrap Up

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at https://mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Atopic Dermatitis Cases & Board Pearls: Eczema Herpeticum/Kaposi’s Varicelliform Eruption, Infection Management, and the Atopic March | The Derm Resident

Host dermatology resident Jonny Hatch and Dr. Peter Leo finish an atopic dermatitis episode with cases and board-focused pearls. They review recognition and urgent management of eczema herpeticum (crusted, punched-out lesions), emphasizing HSV PCR/culture, considering bacterial coinfection, empiric antivirals (valacyclovir/acyclovir) and when IV acyclovir/hospitalization is warranted, plus Tzanck smear and biopsy findings (three Ms). They discuss Kaposi’s varicelliform eruption etiologies including eczema coxsackium (supportive care, possible empiric antiviral while ruling out HSV, and onychomadesis) and a life-threatening eczema vaccinatum story. They cover the atopic march, transcutaneous sensitization, LEAP study implications, and why most eczema doesn’t improve with dietary restriction. Practical guidance includes treating impetiginized AD with drying compresses and topical mupirocin, limited oral antibiotics, updated views on bleach baths, bathing frequency, topical steroid potency by vehicle, dupilumab-associated conjunctivitis theories, IL-31-mediated itch, TSLP signaling, site-specific steroid absorption, and why JAK1 selectivity matters.

00:00 Podcast Intro
00:19 Eczema Herpeticum Case
02:04 Testing and Swabs
03:09 Empiric Treatment Plan
04:05 When to Hospitalize
05:27 Tzanck Smear Basics
06:53 Eczema Coxsackium Overview
07:33 Kaposi Varicelliform Story
10:21 Differentiating Coxsackium
11:32 Atopic March Explained
13:56 Diet and Food Allergy Myths
18:13 Bacterial Superinfection Case
20:11 Topicals and Tea Compresses
21:13 Bleach Baths Reality Check
22:01 Topicals Over Orals
23:50 Bleach Baths and Bathing
27:23 Eczema Herpeticum Drill
28:20 Steroid Potency Vehicles
29:11 Dupilumab Eye Effects
31:22 Itch Pathways Explained
32:22 Eczema Coxsackium Care
34:58 Atopic March TSLP
36:42 Steroid Absorption Sites
37:30 Genital Itch Strategy
39:49 JAK STAT6 and Future
41:41 Wrap Up and Thanks

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at https://mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Atopic Dermatitis Treatment Ladder: Moisturizers, Topical Steroids, Nonsteroidals, Biologics, and JAK Inhibitors (with Dr. Peter Lio) | The Derm Resident

Contact: thedermresident.pod@gmail.com.

Host dermatology resident Jonny Hatch interviews Dr. Peter Lio about atopic dermatitis treatment, emphasizing moisturizers (prescriptive product guidance, National Eczema Association Seal of Acceptance, ointments/petrolatum for stinging) and topical corticosteroid selection by potency, vehicle, and body site, with counseling on rare but important adverse effects and steroid stewardship. They distinguish tachyphylaxis from topical steroid withdrawal, noting evolving recognition and potential mechanistic clues. The episode reviews nonsteroidal topicals (tacrolimus/pimecrolimus counseling, black box warning context, stinging mitigation, crisaborole limitations, roflumilast benefits/rare diarrhea, topical ruxolitinib efficacy and boxed warning counseling), then escalates to systemic therapy with phototherapy, biologics (dupilumab, tralokinumab, lebrikizumab, nemolizumab), and oral JAK inhibitors (upadacitinib, abrocitinib) including risks and lab monitoring. They also discuss limited roles for antihistamines, the Dr. Aron regimen compound, and phage-lysin anti-staph products, and preview part two.

00:00 Welcome and Guest Intro
00:51 Moisturizers as Foundation
02:45 Choosing Eczema Safe Products
05:27 Ointments for Sensitive Skin
07:07 Topical Steroid Ladder Basics
08:43 Potency Picks and Stewardship
11:18 Monitoring Steroid Side Effects
12:45 Eyelids and Steroid Sparing
14:19 Tachyphylaxis vs TSW
17:23 Steroid Mechanism of Action
18:51 Calcineurin Inhibitors Counseling
22:42 Eucrisa and PDE4 Reality Check
24:07 Roflumilast Practical Use
25:59 Topical JAK Inhibitor Opzelura
28:43 Placebo and Adherence
29:14 When to Escalate Care
29:41 Biologics Treatment Targets
31:57 ADCT Control Scoring
32:45 Insurance Documentation Tips
33:24 Dupilumab Side Effects
34:15 Managing Eye Symptoms
36:13 Head and Neck Flares
37:37 Switching Biologics Strategy
39:32 Nemolizumab Itch Control
40:00 Oral JAK Inhibitors Overview
41:45 Black Box Risk Counseling
44:36 Lab Monitoring Schedule
46:13 Antihistamines Reality Check
47:51 Aaron Regimen Compound
51:53 Bacteriophage Spray Future
53:42 Closing and Next Steps

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at https://mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Atopic Dermatitis High-Yield Review: Etymology, Diagnosis, Pathogenesis, Cytokines, Microbiome, Distribution, and Mimickers | The Derm Resident

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Hosts Dr. Jonny Hatch and Dr. Deven Curtis review high-yield atopic dermatitis (AD), covering its 1923 “atopos” etymology, clinical definition, and the atopic march (AD/food allergy in infancy, asthma in childhood, allergic rhinoconjunctivitis in adolescence). They outline AAD diagnostic criteria: pruritus, classic age-specific morphology/distribution, and chronicity, plus intrinsic (IgE-associated) vs non–IgE AD. Pathogenesis is framed as barrier dysfunction, immune dysregulation, and microbiome alteration, highlighting filaggrin’s role, transepidermal water loss, increased skin pH, and unchecked kallikrein proteases; Netherton syndrome (SPINK5/LEKTI) is discussed. They review Th2→Th1 evolution, key cytokines (IL-4/13 targeted by dupilumab; IL-13-only agents; IL-31 “itch cytokine” and nemolizumab), Staph aureus colonization and impetiginization, age-based distribution patterns, site variants and stigmata (Denny-Morgan lines, white dermatographism, keratosis pilaris, ichthyosis vulgaris), complications (ocular disease, eczema herpeticum with IV acyclovir on boards), quality-of-life impact, biopsy rationale (spongiotic dermatitis, rule out mycosis fungoides), and common mimickers and differentials including seb derm, scabies, contact dermatitis, immunodeficiencies, hypereosinophilia causes, nummular dermatitis, SCC in situ, dyshidrotic eczema, and asteatotic eczema.

00:00 Welcome and Topic Setup
00:31 Atopic Derm Name Origin
01:59 What It Is and Atopic March
04:41 Diagnosis Criteria Essentials
06:13 IgE Types and Core Pathogenesis
08:32 Barrier Breakdown and Filaggrin
13:02 Proteases and Netherton Syndrome
15:11 TH2 to TH1 Cytokine Shift
18:09 Dupilumab IL4 IL13 Explained
21:24 IL31 The Itch Cytokine
23:57 Staph Aureus and Microbiome
27:10 Age Based Distribution Infants
27:53 Age Based Distribution
29:32 Site Specific Variants
31:18 Head Neck Dupixent
31:58 Atopic Stigmata Signs
34:24 Ichthyosis And KP
36:09 Ocular Complications
37:55 Eczema Herpeticum Urgency
40:07 Quality Of Life Burden
42:27 When To Biopsy
45:18 Mimickers And Immunodeficiency
49:31 Eosinophilia Differential
50:22 Rapid Fire Dermatitis
53:25 Episode Wrap Up

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at https://mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Rosacea High-Yield Review: Subtypes, Triggers, Treatment Ladder, and Key Differentials (with Dr. Anuj Kunadia) | The Derm Resident

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Link to Rosacea Sketches

Dr. Jonny Hatch welcomes Dr. Anuj Kunadia, founder of DermatoGraphix, to review high-yield rosacea. They distinguish rosacea from acne by the absence of comedones and discuss subtypes: erythematotelangiectatic (erythema/telangiectasias, burning/stinging; often procedural treatment with PDL or IPL), papulopustular (topicals like azelaic acid, metronidazole, ivermectin; oral low-dose doxycycline; isotretinoin if refractory), phymatous (sebaceous hyperplasia/fibrosis; rhinophyma and other “phyma” sites; early isotretinoin vs surgical/laser debulking), and ocular (can precede skin findings; refer to ophthalmology and consider doxycycline). They cover pathogenesis including kallikrein-5/cathelicidin LL-37, Demodex association and ivermectin, common triggers, variants (granulomatous rosacea, rosacea fulminans, Morbihan disease), key differentials (seborrheic dermatitis, lupus), periorificial dermatitis management (stop steroids, pimecrolimus/doxycycline), and conclude with rapid-fire boards questions and an art-history rhinophyma example.

00:00 Welcome and Setup
00:19 Meet the Guest
00:44 Dermatographics Origin
01:52 Classic Rosacea Case
02:30 Rosacea Basics
03:08 Acne vs Rosacea
04:21 Rosacea Subtypes
04:49 ETR Features and Lasers
05:58 Pathogenesis and Demodex
08:55 Triggers and Photoprotection
11:46 Phymatous Rosacea
13:41 Ocular Rosacea Red Flags
15:15 Rare Rosacea Variants
19:34 Key Differentials
23:19 Treatment Ladder Overview
24:23 Topicals for Redness
26:19 Papulopustular Treatments
30:19 Procedures for Rhinophyma
31:03 Periorificial Dermatitis
34:29 Periorificial Treatment Plan
35:47 Rapid Fire Boards Quiz
41:01 Fun Fact and Wrap Up

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at https://mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Acne & Rosacea Pearls with Dr. John Barbieri: Diagnosis, Antibiotics, Isotretinoin Dosing, and Pregnancy-Safe Options | The Derm Resident

In this “Meet the Expert” episode of The Derm Resident, Dr. Jonny Hatch talks with acne and rosacea expert Dr. John Barbieri about practical, early-resident approaches to acne and common mimickers, emphasizing comedones as a key differentiator and reviewing clues for periorificial dermatitis, rosacea, and pityrosporum folliculitis. They discuss why “jawline acne” is not a strong predictor of PCOS/PMOS and why signs like irregular menses, hirsutism, and acanthosis nigricans are more informative. Dr. Barbieri outlines systemic treatment decision-making, favoring spironolactone over long-term antibiotics in many patients, and reviews antibiotic choices and resistance concerns. The conversation then covers isotretinoin timing, dosing to clinical endpoints, adjuncts to reduce flaring and side effects (loratadine, omega-3, L-carnitine), counseling on growth and mood risk, pregnancy-safe acne options, benzoyl peroxide/benzene concerns, rosacea redness treatment (oxymetazoline), and common trainee mistakes.

00:00 Welcome and Guest Intro
00:42 Acne Exam Basics
01:08 Acne Mimickers
02:36 History and PCOS Clues
03:30 Jawline and Hormones
05:26 Systemic Treatment Choices
07:01 Low Dose Doxy Debate
08:59 Antibiotics as Bridge
10:59 Which Antibiotic to Pick
13:35 Starting Isotretinoin (Accutane)
15:46 Dosing and Endpoints
17:32 Cumulative Dose Myths
19:17 Higher Daily Dosing
20:12 Antihistamine Add On
21:09 Omega 3 For Dryness
22:25 L Carnitine For Soreness
23:42 Growth Stunting Myth
24:33 Mood And Suicide Risk
27:02 Acne In Pregnancy
28:09 Topical Combo Strategies
29:23 Benzoyl Peroxide and Benzene
30:41 Resident Mistakes And Rosacea
33:18 Rosacea Phenotype Approach
34:52 Advice For New Residents
35:30 Final Thanks And Wrap

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at https://mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Acne Boot Camp: Pathogenesis, Clinical Evaluation, Variants, Mimickers & First-Line Topicals | The Derm Resident

Hosts Dr. Jonny Hatch and Dr. Deven Curtis introduce The Derm Resident and begin an acne “boot camp” covering high-yield basics for clinic and boards. They review acne’s etymology and outline the four pillars of pathogenesis: follicular hyperkeratinization (microcomedone formation), androgen-driven sebum production (DHT via 5-alpha reductase), Cutibacterium acnes colonization with inflammatory free fatty acids, and inflammation. They discuss clinical morphology and distribution, inflammatory vs noninflammatory lesions, PIH versus true scarring (ice pick, boxcar, rolling, and hypertrophic scars), and diet associations (skim milk, whey protein, high glycemic load, vitamin B12/energy drinks). The episode covers variants and special populations including adult female acne, neonatal/infantile/mid-childhood/pre-adolescent acne (with workup triggers), acne fulminans treatment with prednisone then low-dose isotretinoin, follicular occlusion tetrad, acne excoriée, drug-induced acne, acne mechanica/occupational acne/chloracne, and mimickers like rosacea and gram-negative folliculitis, then closes with topical treatment ladders and key agents (retinoids, benzoyl peroxide, clindamycin, azelaic acid, dapsone, clascoterone).

00:00 Welcome and Focus
00:45 Acne Name Origins
02:15 Acne Pathogenesis Overview
03:24 Hyperkeratinization Explained
04:38 Comedones and Sebum Words
05:59 Androgens and Sebum
07:55 C Acnes and Inflammation
10:00 Diet and Acne Evidence
12:46 Clinical Exam and Severity
14:23 PIH Versus True Scars
17:46 Adult Female Acne
20:06 Acne Fulminans Treatment
23:45 Fulminans Name and Tetrad
25:32 Follicular Occlusion Tetrad
26:54 Pilonidal Cyst Etymology
27:21 Acne Excoriée Explained
28:39 Pediatric Acne Types
32:57 Drug Induced Acne Clues
36:28 Mechanica Occupational Chloracne
39:06 Acne Mimickers Differential
41:27 Hyperandrogenism Lab Workup
44:28 Acne Treatment Ladder
49:56 Topicals Beyond Retinoids
52:33 Systemic Therapy Next Episode
53:03 Wrap Up And Goodbye

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at https://mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Full Body Skin Exam: Sequence, Missed Sites, and High-Yield Lesions for Skin Cancer Screening | The Derm Resident

In episode two of The Derm Resident, hosts Dr. Jonny Hatch and Dr. Deven Curtis walk through a practical approach to the full body skin exam for skin cancer screening, emphasizing the importance of a consistent exam sequence, patient communication, and documenting spots of concern. They review commonly missed sites (scalp, behind ears, interdigital toe spaces, palms/soles, genitals) and note the need for chaperones for sensitive exams. The episode covers high-yield benign lesions (seborrheic keratoses, sebaceous hyperplasia, cherry angiomas, nevi subtypes and dermoscopy patterns, dermatofibromas, lichen planus-like/lichenoid keratosis, skin tags) and premalignant/malignant lesions (actinic keratoses, basal cell carcinoma, squamous cell carcinoma including keratoacanthoma, and melanoma types including subungual melanoma and Hutchinson sign). They close with biopsy pearls, follow-up intervals based on risk, and counseling on warning signs and daily sun protection.

00:00 Welcome and Disclaimer
00:35 Why Skin Exams Matter
00:49 Starting the Encounter
02:37 Building Your Exam Sequence
05:26 Commonly Missed Sites
08:07 Benign vs Malignant Overview
08:29 Seborrheic Keratoses
12:37 Leser Trelat and Boards Pearls
14:14 Sebaceous Hyperplasia
16:27 Cherry Angiomas
18:20 Nevi Types and Aging
23:23 Dermoscopy of Junctional Nevi
25:10 Intradermal Nevi Patterns
25:21 Intradermal Nevus Clues
26:31 Dermatofibroma Exam Pearls
28:41 Lichenoid Keratosis Explained
30:37 Skin Tags Basics
31:38 Actinic Keratosis Recognition
32:55 AK Treatment Options
35:23 Basal Cell Carcinoma Signs
37:46 Squamous Cell and KA Debate
42:27 Melanoma Types and ABCDE
44:55 Subungual Melanoma Hutchinson
47:51 Biopsy Depth and Technique
48:58 Follow Up and Sun Safety
52:01 Final Wrap and Takeaways

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at https://mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Dermatology Morphology Basics: Building Differentials & Primary vs Secondary Lesions | The Derm Resident

Hosts Dr. Jonny Hatch and Dr. Deven Curtis introduce The Derm Resident and outline the podcast’s goal of reviewing dermatologic diseases by pathogenesis, clinical features, workup, and management to help with clinic and boards. They discuss an approach to building differentials using a “tree” framework (neoplastic vs inflammatory, then infectious vs noninfectious) and emphasize that morphology is the core language of dermatology, sometimes outweighing patient history. The episode reviews key primary lesions—macule vs patch, papule vs plaque, nodules, wheals, vesicles vs bullae, and pustules—and explains why precise word choice matters. They then cover secondary changes including scale vs crust, fissures, excoriations, erosions vs ulcerations, atrophy, and lichenification, and end by stressing the importance of palpation in lesion assessment.

00:00 Welcome to the Podcast
00:52 How to Build a Differential
02:38 Disease Buckets and Pathogenesis
05:56 Morphology Is King
08:43 Primary Lesions Basics
11:54 Nodules and Wheals
14:49 Blisters and Pustules
19:52 Secondary Lesions Explained
21:06 Scale vs Crust and Micaceous
24:10 Breaks in the Skin
27:46 Atrophy and Lichenification
30:10 Palpation Pearls
32:17 Wrap Up and Next Episode

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at https://mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.