Innovations in Dermatology Newsletter

September 2022

Daily 3

—by Colleen Hutchinson

Welcome to Day 2 of Medscape’s 17th Annual Hybrid Coastal Dermatology Symposium
If you missed Day 1 or Day 2 sessions, make sure to circle back and check it out here. Hopefully our in-person attendees have been able to enjoy the wonderful benefits (food, shopping, scenery) that Charleston has to offer.

During Medscape’s dynamic Day 3 Session VII at the Coastal Dermatology Symposium, several thought leaders including Vincent A. DeLeo, MD, Kenneth Gordon, MD, and Dirk Elston, MD will be sharing critical insights on the pathogenesis and treatment of atopic dermatitis. Read on to see some highlights to be seen at Day 3 of the conference.

Dr. Vincent A. DeLeo provides the Morning Welcome and Session VII Introduction, and opening session presentations includes Dr. Kenneth Gordon presenting on Treating Moderate to Severe Psoriasis: 2022 and Beyond. 

Day 3 also brings a fresh perspective on things from Dr. Dirk Elston, who is the Editor of the Journal of the American Academy of Dermatology. Dr. Elston will present Best of JAAD and What’s Eating You? Don’t miss!
 
In addition to catching the presentations, make sure to visit our live Q&A panels. The Day 3 interactive panel is sure to be a lively discussion with this mix of faculty and topics. 

As Dr. Pariser pointed out, there are benefits to both in-person and virtual attendance. With in-person you can see the live unfolding of discussion in the interactive panels, where “audience members usually ask incisive questions that amplify the value of the formal presentations.” But you can also view these panels from home, and benefit from the fact that virtual attendance “allows attendees to learn at their own pace in the format of which they are most comfortable.” 

So don’t forget that as a virtual attendee, you can take advantage of robust opportunities to interact with colleagues beyond the educational sessions. Please take full advantage of the virtual conference features that Medscape has provided, including visiting booths and participating in peer-to-peer learning in the Virtual Poster Hall, networking with other dermatology specialists and practitioners (without having to move from your chair!), and accessing the virtual platform on-demand here.

Dr. Linda Stein Gold, faculty, has said, “Attendees really look to this meeting to bring us up to date on what's new in medical dermatology.” During the past couple days, we’ve been treated to excellent coverage and updates on treatment innovations for some of the most challenging skin conditions. We hope you’ve been able to view these presentations this week live, but if not, go online and register here to view any and all sessions of the conference, join us live for this last session, and don’t forget to access all sessions online here. You don't want to miss out!

—by Colleen Hutchinson

 

September 2022

Daily 2

—by Colleen Hutchinson

Welcome to Day 2 of the 17th Annual Hybrid Coastal Dermatology Symposium

If you missed Day 1 yesterday, make sure to circle back and check it out—you can register here if you haven’t. Co-Chair Dr. Joseph Fowler shares that, “Each day of this conference provides up-to-the minute information on the newest treatments in medical dermatology.” 

So what’s on today’s Day 2 agenda? I asked Co-Chair Dr. Vincent DeLeo what goes into the agenda planning. How to decide what to include, what takes priority, and what to keep from previous agendas?

And the answer was simple.

“Most importantly, we aim to give attendees practical information about the care of patients.”

And as for keeping the virtual option and making the symposium hybrid?
It’s a great idea to allow attendees to choose the process that works best for them.”

And what’s in a panel?
Dr. David Pariser shared that the Q&A format lends unique value: “Audience members usually ask incisive questions that amplify the value of the formal presentations.”
But you can also view these panels from home, and benefit from the fact that virtual attendance “allows attendees to learn at their own pace in the format of which they are most comfortable.” Often these panels receive very specific questions on how to use some of the new agents and therapies and how to counsel patients on them. There is also usually a lot of excitement and therefore questions regarding what is still in the pipeline that are gamechangers.

Dr. Fowler, Coastal Dermatology Symposium Co-Chair, speaks today on oral treatments for AD. “We are now in the era of the JAK inhibitors in dermatology,” he stated. “While they are likely to be useful for a variety of dermatologic conditions, AD is the area where we may see the biggest impact. Efficacy seems to be very good, although,” he cautions, “the adverse effect profile needs to be considered when contemplating their use.”

Attendees can also look forward to the latest on biologics for psoriasis and what’s to come. Dr. Fowler explained that in the last decade, “We’ve seen biologics for psoriasis that often allow complete clearance. And in the next decade, I think we’ll see more biologics for use in areas like pruritus and prurigo nodularis along with expansion of our AD treatments.”

Dr. Vincent DeLeo presents on “Diagnosis of Photosensitivity Made Simple.” He stated there is much to discuss here and that we should “Always think drug reaction. Always rule out connective tissue disease.”

Dr. Fowler looks forward to today’s agenda and explained what to expect: “Atopic dermatitis treatment has seen a bunch of advances in all 3 phases—oral, biologic, and topical therapies. We will be discussing what is new in all three. And we’ll hear from the editor of the Journal of the American Academy of Dermatology on many other advances in diagnosis and therapy!”

You can access these presentations on-demand here.

In addition to catching the presentations, case reports, virtual exhibits and poster hall, make sure to visit our live Q&A panels. And don’t forget that as a virtual attendee, you can network with colleagues beyond the educational sessions, visit booths and experience peer-to-peer learning in the Virtual Poster Hall and access the virtual platform for on-demand access. Register here!

by Colleen Hutchinson

 

September 2022

Daily 1

—by Colleen Hutchinson

Welcome to the 17th Annual Hybrid Coastal Dermatology Symposium! What do you get in this symposium? Quite a bit!! Thought leaders present on—and discuss in panels—critical insights on new treatments in psoriasis, atopic dermatitis, rosacea, acne, contact dermatitis, and more. Faculty Dr. Rebecca Smith explained how this new model meets everyone’s needs:

“The hybrid Coastal Dermatology Symposium is a reflection of the times we are now living in and is the way of the future. It is creative, innovative, inclusive, and convenient.”

And the location! Dr. Joseph Fowler, Co-Chair, on Charleston
“Coastal Derm has a long history on the West coast. This year, we felt Charleston—a fine small city for great food and interesting architecture—would be a great change to allow our Eastern seaboard docs to attend more easily and enjoy themselves after sessions!”

And if attending virtually, you can still interact with colleagues beyond the educational sessions via the following:

  • Visit booths in the Exhibit Hall (in person or virtually if you so wish!)
  • Engage in peer-to-peer learning in the Poster Hall
  • Network with other dermatology specialists and practitioners 
  • Access the virtual platform for on-demand access

Opening session presentations include How to Simplify Psoriasis Therapy from Dr. Kenneth Gordon and Moles and Melanoma from Dr. Trilokraj Tejasvi. Dr. Tejasvi also gives us Teledermatology, a new and very timely topic!

Dr. David Pariser presents on Actinic Keratoses and Nonmelanoma Skin Cancer: What's New. “Some pearls from my first presentation on proper treatment of actinic keratosis (AK) include that the AAD Guidelines of Care give the highest rating to cryosurgery, topical imiquimod, 5-U and tirbanibulin, and we will go into more detail on these in person.” 
From Sweating It Out: Managing Hyperhidrosis in Your Patients, he will share some new pearls; for instance, “Did you know that about the same number of people have hyperhidrosis as have psoriasis?”

Session 2 brings us Bicoastal Dermatology from Dr. Vincent DeLeo, Symposium Co-Chair, Advances in Rosacea Therapy from Dr. Julie C. Harper, and My Top 5 in Peds 2022 from Dr. Rebecca Smith, who shared, “Pediatric dermatology has experienced an exciting number of therapeutic advances over the past year, and I am excited to share some, including pipeline products that will revolutionize the way we now treat various conditions.” 
She also presents Atopic Dermatitis Biologics, stating, "Biologics for AD have given our patients never before seen control of disease and symptoms. We will discuss those biologics already on the market and how to optimize results and mitigate potential AEs." Don’t miss!

Also in the second session, Dr. Julie Harper’s first presentation, Advances in Rosacea Therapy, will reveal new and emerging agents in this dermatological therapeutic area. Dr. Harper also shares tips in her Session 3 presentation, Managing Your Acne Patients.  

Look for new treatment options to be shared by Coastal Dermatology Symposium Co-Chair Dr. Fowler in What’s New in Contact Dermatitis 2022. What will he be discussing? “Isothiazolinones are a family of preservatives that are skyrocketing in prevalence. They are found in many personal care products but also in diverse products such as laundry detergents and house paints.”

Dr. Vincent A. DeLeo Diagnosis of Photosensitivity Made Simple

Join us to learn more about the most critical advances in diagnosis and treatment of skin diseases—and how to utilize them. You don't want to miss out!
Register now and capture Days 2 and 3 and whatever you’ve missed!
by Colleen Hutchinson
 

 

September 2022

Hot Topics with Dr. Brian Hibler

Dr. Hibler is a dermatologist with Schweiger Dermatology Group, New York, NY

Introduction

Welcome back to Innovations in Dermatology! We hope you are enjoying the fall season. This month we speak with Dr. Joseph Fowler, who is Professor and Clinical Director, Contact and Occupational Dermatology at the University of Louisville School of Medicine, and is also serving as the upcoming hybrid Coastal Dermatology Symposium Co-Chair and faculty. Dr. Fowler discusses the symposium, as well as findings from his co-authored work with the North American Contact Dermatitis Group Data, what’s new in oral treatments for AD, and what he sees as the biggest advancements in the dermatology landscape over the last decade, as well as what’s to come.

Don’t Miss:
Coastal Dermatology Symposium (17th Annual) HYBRID
Fri/Sat/Sunday September 23-25, 2022; Charleston Marriott; Charleston, South Carolina 

Innovations in Dermatology Fall Conference (2nd Annual) HYBRID
Thurs/Fri/Saturday November 3-5, 2022; Bellagio Hotel; Las Vegas, Nevada 

Social Media Ambassador: Win an all-expense paid trip to Hawaii: Become a Social Media Ambassador for MedscapeLIVE!, an experience like no other! You'll have exclusive access to up-to-date research in dermatology through informative sessions and earn 30 + CME/CE credits at no cost to you. Attendees will have the opportunity to be the first to know about emerging data in their profession. In addition, gain professional connections to help advance your career! Link to apply: https://docs.google.com

Check out our Rapid Fire this issue, and don’t miss this month’s Derm Resource section, with articles from JAMA Dermatology, Dermatology News, Cutis, NEJM and more. Thanks to Dr. Fowler for putting together a cutting-edge agenda and for sharing his expertise! Please contact me at [email protected] with any suggestions, and thanks for reading.

Colleen Hutchinson

 

What’s New and Groundbreaking with Dr. Joseph Fowler 

Joseph F. Fowler Jr., MD is the Conference Co-Chair of the 2022 Coastal Dermatology Symposium, and is Professor and Clinical Director, Contact and Occupational Dermatology at the University of Louisville School of Medicine, Louisville, KY. 

As co-chair of this year’s Coastal Dermatology Symposium, how might the symposium be different from meetings past, and what is the value for the in-person and virtual attendees?
Dr. Fowler:
Coastal Derm has had a long history of being held on the West coast, mostly in famous wine regions. There are a lot of meetings out there and few on the East coast, so we felt this would be a great change to allow our Eastern seaboard doctors to attend more easily. Charleston is a fine small city for great food and interesting architecture, so our in-person attendees should really enjoy themselves after the CME sessions.

What are some of the hottest topics to which we can look forward?
Dr. Fowler:
Atopic dermatitis treatment has seen a bunch of advances in all 3 phases, oral, biologic, and topical therapies. And we’ll hear from the editor of the Journal of the American Academy of Dermatology on many other advances in diagnosis and therapy.

You’ve co-authored some major papers as part of the North American Contact Dermatitis Group Data. What is some of the research from this that you feel will be impactful in the care of your (and others’) patients?
Dr. Fowler:
The NACDG correlates patch test data from our members, and many publications span thousands of patients tested over two decades. The reports we generate help dermatologists understand how common allergy to specific substances is and what clinical situations are most likely to relate to specific allergens.
 
What will be some pearls or takeaways from your Coastal Derm presentation, What’s New in Contact Dermatitis 2022
Dr. Fowler:
Isothiazolinones are a family of preservatives that are skyrocketing in prevalence. They are found in many personal care products, but also in diverse products such as laundry detergents and house paints.

What is new in oral treatments for AD that you’ll discuss in your Session V presentation?
Dr. Fowler:
We are now in the era of the JAK inhibitors in dermatology. While they are likely to be useful for a variety of dermatologic conditions, AD is the area where we may see the biggest impact. Efficacy seems to be very good, although the adverse effect profile needs to be considered when contemplating their use.

What do you think has been one of the biggest advancements in the dermatology landscape over the last decade? What do you think will be the biggest (or one of the biggest) over the next decade? 
Dr. Fowler:
Again, we are right smack in the middle of the JAK inhibitor era. We’ve seen some approvals and expect many more. Also in the last decade, we’ve seen biologics for psoriasis that often allow complete clearance. In the next decade I think we’ll see more biologics for use in areas like pruritus and prurigo nodularis, along with expansion of our AD treatments.

 

Rapid Fire with Dr. Fowler!

Most critical new advance in contact dermatitis treatment: JAK inhibitors
(NACDG) patch testing results: Nickel is still the most common
Contact Dermatitis Associated With Musical Instruments: Metals and acrylics
Most rewarding finding in your research: Helping patients identify the causes of their allergic dermatitis to allow them to stop itching.
Patch test readings and final interpretations by IPDs versus by teledermatologists: Telederm for PT is still very inferior to live viewing
Best new product/tool in my clinical arsenal for AD: JAK inhibitors!

 

Dermatology Resource Section: 

Cutis’s Original Research: Association of BRAF V600E Status of Incident Melanoma and Risk for a Second Primary Malignancy: A Population-Based Study
https://www.mdedge.com

NEJM Original Research: Neoadjuvant Cemiplimab for Stage II to IV Cutaneous Squamous-Cell Carcinoma
https://www.nejm.org/doi/full/10.1056/NEJMoa2209813

Dermatology News: Dig like an archaeologist
https://www.mdedge.com/dermatology/article/257071/business-medicine/dig-archaeologist

JAMA Dermatology Original Investigation: Association Between Inflammatory Bowel Disease and Both Psoriasis and Psoriatic Arthritis
A Bidirectional 2-Sample Mendelian Randomization Study
https://jamanetwork.com/journals/jamadermatology/article-abstract/2795925

Medscape 2nd Annual Innovations in Dermatology Fall Conference, November 3-5, 2022
https://events.medscapelive.org/website/36468/home/

 

August 2022

Hot Topics with Dr. Brian Hibler

Dr. Hibler is a dermatologist with Schweiger Dermatology Group, New York, NY.

Introduction

Welcome back to Innovations in Dermatology! We hope you are enjoying your summer. This month Dr. Brian Hibler joins us for a discussion in the biggest changes in the aesthetic dermatology; what’s in the pipeline in facial rejuvenation (hint: microcoring); social media and what we need to know as the skin experts; and what he anticipates learning at the Fall IID. A member of the faculty of Medscape’s upcoming 2022 IID Fall conference, Dr. Hibler also gives us some pearls that will be shared in depth at the conference. Click here to register for in-person or to virtually access presentations within the confines of your office or home! 

Housekeeping! A little housekeeping to keep the latest CME opportunities on your radar—2 hybrid meetings to add to your calendar—attend in person or online:
Coastal Dermatology Symposium (17th Annual) HYBRID
Fri/Sat/Sunday September 23-25, 2022; Charleston Marriott; Charleston, South Carolina 

Innovations in Dermatology Fall Conference (2nd Annual) HYBRID
Thurs/Fri/Saturday November 3-5, 2022; Bellagio Hotel; Las Vegas, Nevada 

Social Media Ambassador: Win an all-expense paid trip to Hawaii: Become a Social Media Ambassador for MedscapeLIVE!, an experience like no other! You'll have exclusive access to up-to-date research in dermatology through informative sessions and earn 30 + CME/CE credits at no cost to you. Attendees will have the opportunity to be the first to know about emerging data in their profession. In addition, gain professional connections to help advance your career! Link to apply: https://docs.google.com/

Check out our Rapid Fire this issue, and don’t miss this month’s Derm Resource section, with articles from JAMA Dermatology, Dermatology News, Cutis, NEJM and more. Thanks to Dr. Hibler for sharing his expertise! Please contact me at [email protected] with any suggestions, and thanks for reading.

Colleen Hutchinson

 

What’s New and Groundbreaking with Dr. Brian Hibler 

What do you think will be one of the biggest changes in the aesthetic dermatology landscape 10 years from now? 
Dr. Hibler:
I think we are just scratching the surface on what we can do with personalized medicine in dermatology. I think we will see advances in topical cosmetic treatments using exosomes and other novel molecules to influence cellular behavior – whether it is to modulate pigment production, improve healing after surgery or cosmetic treatments, stimulate hair growth, or induce new collagen formation. 

You had said before that “so many new devices have hit the market recently, and I find it helpful to hear first-hand accounts of other physicians whom I trust regarding their experiences with these devices to inform my decision on which I should consider implementing in my office. There are so many cosmeceutical products hitting the market - I hope to learn more from Dr. Watchmaker and Dr. Kaminer regarding any that stand out in their opinion as being essential to incorporate into a good prejuvenation regimen.”  
Do you anticipate learning similarly at the Fall IID?

Dr. Hibler: Absolutely! The Innovations in Dermatology Conference is a wonderful blend of medical and cosmetic topics where I get exposure to cutting edge treatments from the experts who are pioneering them in their clinics. These are colleagues I admire and trust, and I value their input regarding new treatment paradigms that are emerging. I cannot wait to reunite with everyone once again and learn from one another!

At the Fall IID, you are presenting on “Everything You Wanted to Know About Skincare But Were Afraid to Ask.” What do you find are questions people are afraid to ask? 
Dr. Hibler: I find people always want to know more about supplements and natural remedies for their skin, hair, and nails—what works and what doesn’t work. There is a lot of direct-to-consumer marketing out there promoting at-home cures for all sorts of dermatologic conditions. The rise of social media and influencers is only fueling this more. As the skin experts, we need to be up to date on the latest evidence to support or reject these marketing claims. 

There is a lot of excitement about what is still in the pipeline in facial rejuvenation. What is in the pipeline that you expect to be most effective and/or groundbreaking? 
Dr. Hibler:
I’m excited about future applications of the novel microcoring technology. This device (Ellacor, Cytrellis Inc.) is the first of its kind to treat wrinkles and skin laxity by removing microscopic cores of skin with hollow needles, resulting in scarless healing and tissue tightening. This new technology will hopefully open the door to other devices, allowing us to address tissue laxity in other body sites (neck, abdomen, etc.) and will be interested to evaluate to augment transdermal uptake of topical medications to treat different skin conditions.

At the spring Medscape IID, in presenting on body contouring, you stated, “For most body contouring procedures, patients should be at or near their goal weight and lead a healthy lifestyle. Many of the treatments provide subtle yet noticeable results but require some work on the part of the patient to maintain and build upon the results.” What is your patient screening process as it relates to the weight and lifestyle status of a potential patient? 
Dr. Hibler: When screening patients for body contouring procedures, I look at the degree of adiposity, tissue laxity, and quality of the overlying skin, and their goal weight. We always review healthy lifestyle choices to augment their body contouring procedures. I counsel patients that sometimes it is best to delay treatment until they are at or near their goal weight in order to achieve the best results. However, sometimes a treatment might help motivate them to continue to work toward achieving their goal weight. I have these patients return 1 to 2 months after treatment to check in and make sure they are progressing, and to discuss future steps to help reach their goal.

In discussing your recent Medscape IID presentation this past April, Prejuvenation: Topical and Preventive Measures, you shared the following state of the union summary on the topic: “Patients seeking prejuvenation treatments wish to maintain a natural look without exaggerated changes. They desire minimally or non-invasive treatments that have little to no downtime and are safe with low risk of adverse effects. The most popular minimally invasive cosmetic treatments for my prejuvenation population include neuromodulators (e.g. Botox, Dysport, Xeomin, Jeuveau), dermal fillers (e.g. Restylane, Juvederm), laser treatments such as intense pulsed light (IPL) or fractional non-ablative lasers like the Clear and Brilliant laser, and ultrasound or radiofrequency devices to stimulate collagen production and provide a little lifting and tissue tightening.” Are most providers trained adequately on all these options, and if not, where can they look to develop mastery of such a broad arsenal? 
Dr. Hibler: Cosmetic treatments are not without risk, and often on social media influencers and non-dermatologists will glamorize aesthetic treatments while neglecting to mention the potential adverse events that can occur. It is important to see a board-certified physician with requisite training in cosmetic procedures to not only minimize the risk of a complication, but to be seeing someone who is knowledgeable and trained to handle any complication, should one arise. As dermatologists, we undergo rigorous training in cosmetic injectable, laser, and energy-based device treatments. I wished to learn advanced injection and laser techniques, so I did an additional year of training at Massachusetts General Hospital with Dr. Mat Avram. There, I was exposed to a whole arsenal of laser and energy-based devices to learn the principles of laser surgery and advanced techniques to achieve the best outcomes.

 

Rapid Fire with Dr. Hibler

Most critical new advance used in my practice: Combination photodynamic therapy and laser for recalcitrant acne.
Biggest misconception patients have: Removing growths or performing an excision won’t leave a scar or mark on the skin. 
Best new product/tool in my clinical arsenal: SofwaveTM –ultrasound tissue tightening device.
Something I learned or came away with from the IID Spring Conference: Recommendations for individualizing OTC skincare for different Fitzpatrick skin types
Biggest challenge in body sculpting: Dealing with skin laxity

 

Dermatology Resource Section: 

Cutis’s Original Research: Discrepancies in Skin Cancer Screening Reporting Among Patients, Primary Care Physicians, and Patient Medical Records
https://www.mdedge.com

NEJM Original Research: Trial of Anti-BDCA2 Antibody Litifilimab for Cutaneous Lupus Erythematosus
https://www.nejm.org/doi/full/10.1056/NEJMoa2118024

Dermatology News: Second opinions on melanocytic lesions swayed when first opinion is known
https://www.mdedge.com

JAMA Dermatology Editorial: Molluscum Contagiosum Therapeutics—New Options May Be Around the Corner
https://jamanetwork.com/journals/jamadermatology/article-abstract/2794190

Medscape 2nd Annual Innovations in Dermatology Fall Conference, November 3-5, 2022
https://events.medscapelive.org/website/36468/home/

 

 

July 2022

What’s New and Groundbreaking with Dr. Peter Lio 

Dr. Lio is Clinical Assistant Professor of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Founding Director, Chicago Integrative Eczema Center, Founding Partner, Medical Dermatology Associates of Chicago, Chicago, Illinois.

 

Welcome back to Innovations in Dermatology! We hope you are enjoying your summer. This month Dr. Peter Lio joins us for a discussion in the latest advances for eczema; two oral agents for AD that are new in 2022—how they fit into the therapy landscape and some advice on patient selection and monitoring; products in the pipeline expected to be effective and groundbreaking; the upcoming 2022 IID Fall conference; and new therapies for warts & molluscum contagiosum. A member of the faculty of Medscape’s recent Spring IID, Dr. Lio also shares some takeaways from the conference. Speaking of the conference, if you are interested in  conference on-demand access, click here to virtually access presentations within the confines of your office or home! 

Check out our Rapid Fire as well, in which Dr. Lio opines on patch testing on dupilumab, topical cannabinoid products, the most surprising and the most rewarding findings in his research, and more.

Don’t miss this month’s Derm Resource section that includes articles from JAMA Dermatology, Dermatology News, Cutis, NEJM and more.

Thank you to Dr. Lio for giving us his pearls and tips! Please contact me at [email protected] with any feedback, comments, or suggestions, and thanks again for reading!—Colleen Hutchinson

 

What’s New and Groundbreaking with Dr. Peter Lio 

After what you described as “decades of therapeutic drought for atopic dermatitis (AD),” two new oral agents have been approved for AD in the US in 2022. How do they fit into the therapy landscape, and what is your advice on patient selection and monitoring?
Dr. Lio: They are both pretty exciting and, frankly, they are very similar to each other in almost every aspect. These new medications, upadacitinib and abrocitinib, both belong to the JAK inhibitor class and are sort of the “last word” on more moderate to severe refractory eczema. They are really designed for those cases that have failed topical approaches and, even according to the labeling, have either failed or are not appropriate candidates for other systemic agents, including the biologics. 

My sense is that they both work very quickly—some of my patients have reported noticeable improvement in just a few days—and have a great magnitude of effect. I have been able to get patients who, for example, were stuck at moderate disease severity with other approaches to clear, and that is something worth celebrating. 

What makes them a little more challenging to navigate is that they require monitoring due to their risks and the black box warning that has been applied class-wide. The warning mentions malignancy risk, major adverse cardiovascular events, and thrombosis risk, to name a few. And for monitoring—though I ask every clinician to confirm and use the most up-to-date guidance and recommendations—thus far I have done the following: 

  • Baseline labs and annually: CBC, CMP, Lipids, Hepatitis screen, TB test
  • 1st month: CBC, CMP, Lipids
  • 3rd month: CBC, CMP, Lipids
  • Every 2-3 months thereafter if reassuring: CBC, CMP, Lipids

For your Interactive Q&A with Drs. Eichenfield, Abuabara, and Armstrong at the Spring IID, and the second one with Drs. Eichenfield, Sugerman, and Siegfried, you anticipated very specific questions about use of some of the new agents and counseling patients on them. What were some examples of questions you received?
Dr. Lio: One powerful question was: “When and how does one stop?” And the truth is that we don’t really have formal guidance on this, but I like to impress upon my patients that “nothing is forever” and that our goal is to maintain good control for several months or perhaps even a year. Then if things seem truly quiet and healed, I believe that at least some patients may be able to come off their systemic agents and enter a state of relative remission. I think this is a tremendously exciting area in dermatology!

Another thoughtful question surrounds contraindications for the JAK inhibitors. A situation such as someone having a distant history of a DVT is really tough: while it is not a contraindication in the strict sense, it may shift the balance of JAK inhibitor in terms of efficacy vs. safety. These are always the toughest scenarios, and I think the only answer lies in transparence and shared decision-making together with the patient.

There is a lot of excitement about what is still in the pipeline in your specialized area of dermatology. What is in the pipeline that you expect to be most effective and/or groundbreaking? 
Dr. Lio: Apparently there are over 100 new treatments in development for AD! It’s hard to imagine that, even if only a portion of them make it through the development process, we may have an exciting but crowded market! There are a lot of them that I am following eagerly… One that I have been following for quite some time is tapinarof. It is a topical agent that was just approved for treatment of psoriasis in the US, but apparently they will be seeking AD approval as well. Tapinarof is non-steroidal, apparently quite powerful, and—perhaps most excitingly—thought to be able to achieve remission (i.e., medication-free states) in many patients. I am eager to try it, especially in sensitive areas like the face/eyelids.

Another is the IL-31 inhibitor called nemolizumab. I’ve also been following this for quite some time. While the IL-4/13 pathway is heating up with some competition (which is fantastic!), it is exciting to see a totally different pathway, sometimes called that of the “master itch” cytokine, IL-31. Stay tuned…

As a Co-Chair for the upcoming 2022 IID Fall conference in early November, what are your goals for the meeting agenda and how did you approach it?
Dr. Lio: I really think that the future is smaller, more focused, and much more personalized meetings. I think the goals—beyond having world-class educators and cutting-edge ideas and approaches—is to try to ensure that everyone gets something out of the conference. Sometimes, as cheesy as it sounds, it can come from those 10-minute chats between sessions or while getting coffee. 

In discussing your recent Medscape IID presentation this past April, Expert Insights in the Treatment of Warts & Molluscum Contagiosum, you stated: “Warts and molluscum are among the most common and sometimes the most frustrating things we treat, particularly in children. While we have many therapeutic choices from the past, we are on the cusp of several new therapies that may change the way we approach these common conditions.” What are these therapies, and how accessible will they be to patients and providers?
Dr. Lio: The new topical cantharidin is hopefully coming soon for molluscum and holds the promise of a very well-designed new applicator for each patient. I think this will hopefully open up the treatment of molluscum a bit because, for a number of years, we have been inundated with molluscum in our office! Another molluscum treatment that is in the works uses a nitric oxide releasing topical gel that also seems to be effective and can be applied at home. It will be so nice to have a home treatment for molluscum that is FDA-approved!

 

Rapid Fire with Peter Lio! 

Most critical new advance in AD treatment: Achieving stable remission!
Best new product/tool in my clinical arsenal: Oral JAK inhibitors
Most interesting recent presentation I attended: Suggesting that environmental pollutants are driving all the allergic diseases we are seeing. It was compelling!
Something I learned or came away with from the IID Spring Conference: Dermatology is dynamic and ever-growing!
Patch testing on dupilumab: Reliable or Not? Yes! It really can still be useful for some patients, though it may not be as good as doing it off dupilumab. Still, probably worth it for someone who is still suffering while on dupilumab.
Most surprising finding in your research: That massaging LI11 acupressure point really does help decrease the itch of eczema!
Most rewarding finding in your research: That written eczema action plans really do make a difference.
Topical cannabinoid products for dermatologic conditions: I use one in particular, CQuell Balm, and have to say that it has been fantastic for very dry skin and, in particular, for wounds! They are not all equal, however, so there may be some trial and error.

Dr. Lio reports research grants/funding from AOBiome, Regeneron/Sanofi Genzyme, and AbbVie; is on the speaker's bureau for Regeneron/Sanofi Genzyme, Pfizer, Incyte, Hyphens Pharma, LEO, Eli Lilly, Galderma, and L'Oreal; reports consulting/advisory boards for Almirall, ASLAN Pharmaceuticals, Bristol-Meyers, Dermavant, Regeneron/Sanofi Genzyme, Merck, Pfizer, LEO Pharmaceuticals, AbbVie, Eli Lilly, Micreos (stock options), L'Oreal, Pierre-Fabre, Johnson & Johnson, Unilever, Menlo Therapeutics, Theraplex, IntraDerm, Exeltis, AOBiome, Realm Therapeutics, Altus Labs (stock options), Galderma, Arbonne, Amyris, Bodewell, Burt's Bees. In addition, Dr. Lio has a patent pending for a Theraplex product with royalties paid and is a Board member of the National Eczema Association.

 

Dermatology Resource Section: 

Cutis’s Clinical Review: What’s Diet Got to Do With It? Basic and Clinical Science Behind Diet and Acne
https://www.mdedge.com

NEJM Clinical Implications of Basic Research: Cellular Memories — More Than Skin Deep
https://www.nejm.org/doi/full/10.1056/NEJMcibr2118516

Dermatology News Cosmeceutical Critique: Is benzophenone safe in skin care? Part 2: Environmental effects
https://www.mdedge.com/dermatology/article/255264/aesthetic-dermatology

JAMA Dermatology Editorial: Lessons That Are Never Forgotten—The Unknown Session
https://jamanetwork.com

Medscape 2nd Annual Innovations in Dermatology Fall Conference, November 3-5, 2022
https://events.medscapelive.org/website/36468/home/

Cutis Commentary: Adapting to Changes in Acne Management: Take One Step at a Time
https://www.mdedge.com

2nd Annual Innovations in Dermatology Spring Conference: Agenda Online Here:
https://events.medscapelive.org/website/32348/home/

 

 

June 2022

Breaking Down the Mix with Dr. Jacqueline Watchmaker

Bio sentence here: Dr. Watchmaker is a board-certified dermatologist at Southwest Skin Specialists in Scottsdale, Arizona and is fellowship trained in cosmetic and laser medicine.

Welcome back to Innovations in Dermatology! This month we speak to a member of the faculty of Medscape’s recent 2022 Innovations in Dermatology Spring Conference, Dr. Jacqueline Watchmaker, shares some takeaways from the conference and from her own research and experience in cosmetic and laser medicine. We talk about new techniques and new literature on neuromodulators and soft tissue fillers, optimizing skin tightening devices, and her presentation Nonsurgical Skin Tightening: Who, What, Where, and When?
If you are interested in conference on-demand access, click here to virtually access presentations within the confines of your office or home!
Also, don’t miss this month’s Derm Resource section that includes articles from JAMA Dermatology, Dermatology News, Cutis, NEJM and more.
Thank you to Dr. Watchmaker for giving us her pearls and tips! Please contact me at [email protected] with any feedback, comments, or suggestions, and thanks again for reading!

Colleen Hutchinson

 

Breaking Down the Mix with Jacqueline Watchmaker 

In discussing your recent talk “Toxin and Filler Updates” at Medscape LIVE’s Women’s and Pediatric Dermatology Seminar,, you covered “new techniques and new literature on neuromodulators and soft tissue fillers.” What do we now know that can impact our practice, inclusive of clinical updates (that may differ from previous standards)?
Dr. Watchmaker: Over the past few years, new anatomical studies as well as new safety studies have helped shape the way we inject to better optimize aesthetic outcomes and increase patient safety. For example, a relatively recent anatomical study discussed the role of the facial platysma in lower face contour.  Since this study, many injectors now target the facial platysma when treating the lower face with neuromodulators. Additionally, new safety studies, specifically regarding cannula use, have also changed the way many physicians inject. 

Regarding skin tightening devices, what are some of your personal tips and tricks on how to optimize the patient's aesthetic outcome?
Dr. Watchmaker:
Skin tightening devices such as radiofrequency and micro-focused ultrasound are great devices that cause collagen contraction, neocollagenesis and skin tightening.  The best way to optimize a patient’s aesthetic outcome with these devices is to pick appropriate patients. Patients with mild to moderate skin laxity, especially along the lower face and jawline, are the best candidates for these procedures. If a patient has severe skin laxity, I typically counsel them that a surgical approach is likely going to give them the aesthetic outcome they are looking for. 

At Medscape’s second annual Innovations in Dermatology Spring Conference, you took part in the Demonstration Workshop: Fillers and Injections, which Dr. Kaminer described as “a dynamic session live demonstration using a combination of remote video linkage and a panel of superb injectors.” Can you tell us a little about this and the live body contouring demonstration, and what attendees came away with from each? 
Dr. Watchmaker: In the filler and injectable live demonstration I used a variety of different hyaluronic acid fillers to treat the midface, lower face, temples and superficial rhytids. In addition, I used a neuromodulator to treat the upper face, lower face and neck. Throughout the demonstration Dr. Kaminer, Dr. Weinkle and Dr. Lorenc shared their personal tips and tricks on injectables and how they optimize their patient’s aesthetic outcomes. In the live body contouring session, I demonstrated how to use poly-L-lactic acid to contour the thighs and buttock, how to use collagenase to treat cellulite, and how to use a monopolar radiofrequency device to reduce fat and tighten skin. Dr. Kaminer, Dr. Hibler and I discussed proper patient selection for these body contouring procedures as well as how to counsel and manage patient expectations. 

 At the same meeting, you presented on “Nonsurgical Skin Tightening: Who, What, Where, and When.” You stated, “A number of factors contribute to skin laxity, such as degradation of collagen and elastin with age, redistribution of subcutaneous fat, excessive UV light exposure, and changes in hormone levels. There are many nonsurgical skin tightening procedures available for patients today.” Can you highlight the most promising of these? 
Dr. Watchmaker: In my lecture on nonsurgical skin tightening I discussed micro-focused ultrasound, radiofrequency, lasers and micro-coring. I think all of these devices can be excellent for the right patient. Micro-coring is the newest of these technologies and involves physically removing full thickness micro-cores of skin that are below the size threshold that causes a scar. I look forward to seeing future studies on this device and to hopefully have it soon in my clinic!

 
Thought Leader Rapid Fire (just a few words here that’s your gut reaction to the items listed)

Most critical new advance in facial aging treatment: a longer acting neuromodulator 
Radiation tattoo removal: can make a huge impact on cancer survivors 
Effectiveness of laser safety programs in clinical practice: helpful 
Best new product/tool in my clinical arsenal: microneedling radiofrequency for necks 
Most interesting recent presentation I attended: “Hair today…and tomorrow: What’s New in Hair Disorders” by Dr. Maria Hordinsky. 
Impact of COVID-19 on ASDS Cosmetic Fellowships: Made some components of fellowships stronger (fostered new virtual relationships, new national journal clubs emerged, more time for clinical research etc.)
Something I learned or came away with from the IID Spring Conference: so many new advances in cellulite!

 

Dermatology Resource Section: 

Dermatology News Commentary: Cutis’s Going Beyond Hydroquinone: Alternative Skin Lightening Agents
https://www.mdedge.com/dermatology/article/255255/pigmentation-disorders/going-beyond-hydroquinone-alternative-skin

2nd Annual Innovations in Dermatology Spring Conference: Agenda Online Here:
https://events.medscapelive.org/website/32348/home/

NEJM Article: Two Phase 3 Trials of Baricitinib for Alopecia Areata
https://www.nejm.org/doi/full/10.1056/NEJMoa2110343

Dermatology News Aesthetic Dermatology Update: Understanding filler reversal with hyaluronidase
https://www.mdedge.com/dermatology/article/255564/aesthetic-dermatology/understanding-filler-reversal-hyaluronidase

JAMA Dermatology Editorial: Lessons That Are Never Forgotten—The Unknown Session
https://jamanetwork.com/journals/jamadermatology/article-abstract/2793098?widget=personalizedcontent&previousarticle=2791834

Cutis Original Research: Assessing Treatment Delays for Vitiligo Patients: A Retrospective Chart Review
https://www.mdedge.com/dermatology/article/255409/pigmentation-disorders/assessing-treatment-delays-vitiligo-patients

 

 

May 2022

Daily 2

—by Colleen Hutchinson

Welcome to the final day of Medscape LIVE’s Women’s and Pediatric Dermatology Seminar, which concluding tomorrow. The conference is a hybrid event, so if you missed it in person, you have the option of attending virtually with the conference being live streamed!

At Day 1 of the 2022 conference, faculty shared critical insights on current issues and challenges in dermatology. Whether in person or online, you will come away with critical information and updates on treatment options and diagnoses that you will find immediately useful in the care of your patients. Medscape LIVE! brings you up to speed on these latest advances in patient care.

Register here for online access and take advantage of the virtual features Medscape has provided, including visiting booths in the Virtual Exhibit Hall (without having to move from your chair!), participating in peer-to-peer learning in the Virtual Poster Hall, networking with other dermatology specialists and practitioners, and accessing the virtual platform for on-demand access. 

As an in-person and virtual attendee, you will have robust opportunities to interact with your colleagues beyond the educational sessions. We encourage you to take full advantage of these conference features in which you can:

  • Visit booths in the Exhibit Hall
  • Benefit from peer-to-peer learning in the Poster Hall
  • Network with other dermatology specialists and practitioners

Dr. Lawrence Eichenfield, Co-Chair of this event with Dr. Linda Stein Gold, especially looked forward to Day 1’s session with Dr. Vivian Shi, on biologics in women, as well as an update on atopic dermatitis that works through some cases of psoriasis and atopic dermatitis. “In this we show our approach to decision making and counseling in our age of rapidly changing therapeutics.” Other not-to-miss presentations he mentioned were Dr. Hightower’s session on hidradenitis and hyperhidrosis, Dr. Brian Berman’s presentation on new treatments for scarring and keloids, and Dr. Dawn Eichenfield’s update on protoprotection.

Just some of the topic and clinical pearls shared on Day 2 that attendees of LIVE’s Women’s and Pediatric Dermatology Seminar today include the Skin of Color Spotlight, Seeing Red? Rosacea Update, Hair Today... and Tomorrow: What's New in Hair Disorders, and more!

In the final session of Day 2, Dr. Watchmaker presents again, this time with “Toxin and Filler Update: Best Practices & Innovations." She stated, “In this lecture, I will discuss new techniques and new literature on neuromodulators and soft tissue fillers.  I will focus on the use of neuromodulators in the lower face, the origin technique for neuromodulator injections, the needle vs cannula debate and the use of aspiration prior to filler injection.  Additionally, I will discuss a new neuromodulator and a new soft tissue filler that will soon be available in the US.” 

Also in this final session, Dr. Shehla Admani speaks on “Warts New? Innovations in Treatment in Warts and Molluscum” and also co-presents on “Challenging Cases in Women and Children” with Maria Hordinsky, MD. Find them here!

Medscape wraps up the conference with an Interactive Panel Discussion by panelists and faculty, Drs. Shehla Admani, Lawrence F. Eichenfield, Maria Hordinsky, and Jacqueline Watchmaker.

Join us to learn this and more about critical advances in diagnosis and treatment in women’s and pediatric dermatology to better help your patients. Don’t miss it!

—by Colleen Hutchinson
 

 

May 2022

Daily 1

—by Colleen Hutchinson

Welcome to Medscape LIVE’s Women’s and Pediatric Dermatology Seminar, which stretches over both today and tomorrow. Presented hybrid this year, you have the option of attending virtually with the conference being live streamed in addition to attending live at the Hyatt Regency Huntington Beach, Huntington Beach, California!
At this dynamic hybrid 2022 conference, faculty share critical insights on current issues and challenges in dermatology, and clinically relevant information that you will find immediately useful in the care of your patients. This meeting will bring you up to speed on all the latest advances in patient care for you to take back to your practice today!

“We have an incredible set of exciting, diverse dermatology experts speaking at our Women and Pediatric Dermatology Meeting,” commented Dr. Lawrence Eichenfield, Co-Chair of this event with Dr. Linda Stein Gold. “I am especially excited to share a session with Dr. Vivian Shi, who will discuss biologics in women, and after an update on atopic dermatitis that I will present, work through some cases of psoriasis and atopic dermatitis, showing our approach to decision making and counseling in our age of rapidly changing therapeutics. Other cool talks I am looking forward to include Dr. George Hightower’s Hidradenitis and Hyperhidrosis session, Dr. Dawn Eichenfield’s Update on Protoprotection and a master of management of scars, Dr. Brian Berman’s talk on new treatments for scarring and keloids.”

Just some of the topic and clinical pearls shared that attendees can bring home as well from LIVE’s Women’s and Pediatric Dermatology Seminar today include Biologics and Women, Developments in Atopic Dermatitis: Scratching Below the Surface, Case Challenges in Atopic Dermatitis and Psoriasis, 
Feed Me! Nutritional Approach to Select Skin Diseases, It's the Pits! Hyperhidrosis and Hidradentitis Suppurativa, Stop Picking on Me! Acne Across the Lifespan, and more!

If unable to attend in person, register here and take advantage of the virtual features Medscape has provided, including visiting booths in the Virtual Exhibit Hall (without having to move from your chair!), participating in peer-to-peer learning in the Virtual Poster Hall, networking with other dermatology specialists and practitioners, and accessing the virtual platform for on-demand access. 
As an in-person and virtual attendee, you will have robust opportunities to interact with your colleagues beyond the educational sessions. We encourage you to take full advantage of these conference features in which you can:

  • Visit booths in the Exhibit Hall
  • Benefit from peer-to-peer learning in the Poster Hall
  • Network with other dermatology specialists and practitioners

According to Co-Chair Linda Stein Gold, the first day of the Women's and Pediatric Dermatology Seminar has so far been a great success. “There was a great review of hot topics including atopic dermatitis, nutritional approaches to skin disease, scars and HS, pediatric emergencies and more. The speakers were engaging and very approachable. I am really looking forward to Day 2!”

In Session IV today, Dr. Jacqueline Watchmaker presents on “Aesthetics: Approach to the Aging Face." She stated, “In this lecture, I discuss anatomical changes that occur with age and a variety of aesthetic treatment options such as neuromodulators, soft tissue fillers, skin tightening devices and lasers. I will discuss proper patient selection for various treatments, delve into the science behind skin tightening devices and share my personal tips and tricks on how to optimize the patient's aesthetic outcome.” 
Medscape wraps up Day 1 with an Interactive Panel Discussion by panelists and faculty, Drs. Shehla Admani, Lawrence F. Eichenfield, Maria Hordinsky, and Jacqueline Watchmaker.

Join us to learn this and more about critical advances in diagnosis and treatment in women’s and pediatric dermatology to better help your patients. Don’t miss it!

by Colleen Hutchinson
 

 

May 2022

A Look Back at the 2nd Annual Innovations in Dermatology (IID) Spring Conference!

We’re back in your inbox this month with a new issue of Innovations in Dermatology. Our three co-chairs and planners of Medscape’s 2022 Innovations in Dermatology Spring Conference, Drs. Michael Kaminer, Linda Stein Gold, and Lawrence Eichenfield, share some takeaways from the conference.
There was plenty for attendees to take back to their practice, from a first of its kind workshop for aesthetics, to new developments in topical therapy for psoriasis, atopic dermatitis, pediatric treatments, and new treatments in face and body aesthetics. There was also a new skin of color dermatology spotlight, three medical dermatology forums, a guide to new treatments for cutaneous malignancies, and an OTC skincare playbook. If you are interested in hearing more on the clinical pearls shared here from the co-chairs of the meeting, you’re in luck, because each session is available for immediate on-demand access following the conference. Register here to virtually access presentations from the conference within the confines of your office or home!
Also, don’t miss this month’s Derm Resource section that includes articles from JAMA Dermatology, Dermatology News, Cutis, NEJM and more.
Thank you to our doctors this month for giving us their perspective on pearls from the conference! Please contact me at [email protected] with any feedback, comments, or suggestions, and thanks again for reading!

Colleen Hutchinson

 

What Was Hot at Medscape’s 2022 IID 

What did you come away with from the meeting that you can incorporate into practice today? 
Dr. Eichenfield:
Approach to screening and monitoring for JAK Inhibitors for atopic dermatitis. 

Dr. Stein Gold: A better understanding the laboratory monitoring of oral JAK inhibitors.

Dr. Kaminer: Utilizing multiple modalities to treat cellulite. Several presentations highlighted the synergistic nature of the available cellulite treatments.

This year’s IID was especially anticipated coming following Covid and the all-virtual meetings. Did you find the meeting to be as dynamic and compelling as years past given this pause?
Dr. Stein Gold:
I found this meeting to be more dynamic than in the past.  Everyone was thrilled to mingle and engage in person.

Dr. Eichenfield: Yes! The breadth of faculty knowledge and expertise was tremendous, and both attendees and faculty brought energy and interest to the meeting. It was great to have face to face opportunities to talk to dermatologists and derm Pas/NPs from all over the US, and to answer their questions one on one. And, in parallel, incredible to see the hundreds of attendees on-line asking questions and making comments, including some from Australia and other locations far from Scottsdale.

Dr. Kaminer: Absolutely! While we are all slowly and cautiously re-entering the world of medical conferences, the IID stood out as a unique opportunity to reconnect with colleagues and resume learning in an exciting format. The combination of live and virtual attendees widened the audience and added a dynamic aspect to the meeting.

What is some of the best shared research from the meeting that moves the needle on treatment options?
Dr. Eichenfield:
Some of the best shared research that moves the needle on treatment options for our patients is development of oncodermatology as a subfield of dermatology expertise. The wide range of medication side effects, eruptions, impact on skin, hair and nails, and ways to recognize, treat and even prevent them is a truly impactful, evolving area of work.

Dr. Stein Gold: Data on new treatments for AD and psoriasis show that we can treat our patients more effectively than ever.

Dr. Kaminer: The pending approval of Dacia botulinum toxin is an exciting development that has the potential to significantly advance our wrinkle reduction capabilities.

 

Dermatology Resource Section: 

Dermatology News Article: Acid series: Trichloroacetic acid
https://www.mdedge.com

2nd Annual Innovations in Dermatology Spring Conference: Agenda Online Here:
https://events.medscapelive.org/website/32348/home/

NEJM Article: Peers, Professionalism, and Improvement — Reframing the Quality Question
https://www.nejm.org/doi/full/10.1056/NEJMms2200978

Dermatology News: Merging small practices
https://www.mdedge.com/dermatology/article/253908/business-medicine/merging-small-practices

JAMA Dermatology Original Investigation: The Power of a Palliative Perspective in Dermatology
https://jamanetwork.com/journals/jamadermatology/article-abstract/2791834

Cutis Original Research: Impact of the COVID-19 Pandemic on Characteristics of Cutaneous Tumors Treated by Mohs Micrographic Surgery
https://www.mdedge.com

NEJM Original Article: Phase 2 Trial of Iberdomide in Systemic Lupus Erythematosus
https://www.nejm.org/doi/full/10.1056/NEJMoa2106535

Cutis Article: BRAF V600E Expression in Primary Melanoma and Its Association With Death: A Population-Based, Retrospective, Cross-Sectional Study
https://www.mdedge.com
 

 

April 2022

Daily 4

by Colleen Hutchinson

Welcome to the final day of Medscape’s second annual Innovations in Dermatology Spring Conference! During the past few days, we’ve been treated to excellent coverage and updates on treatment innovations for some of the most challenging skin conditions. We hope you’ve been able to view these presentations this week live, but if not, go online and register here to view sessions from all 4 days. 
Today’s agenda includes Session IX—The Cutting Edge on Cutaneous Malignancies, Session X—Spotlight on Skin of Color in Dermatology, and Session XI—The OTC Skincare Playbook.
This year’s conference so far has proven to be a critical venue for sharing updates that have occurred over the last two years that COVID has canceled in-person meetings. Co-chair Dr. Michael Kaminer offered insights on the unique value of this year’s conference: “Since many of us have not attended a live meeting in several years, this Medscape IID, with its broad scope of current dermatology research and treatment options, provides an opportunity to really hit the reset button in terms of skills and education.”

Read on for some insights regarding critical content being shared at today’s conference—and thank you for reading!

Dr. Vishal Patel will speak today on “Expert Perspectives on Managing Patients with Cutaneous Squamous Cell Carcinoma.” He gave us a glimpse of what to expect: “Briefly, my talk will focus on how providers can be risk stratify the breadth of cutaneous squamous cell carcinoma, including in situ and actinic keratosis disease. We will discuss risk assessment and how to best pair that with cost-effective and evidence-based treatment and management strategies to provide the best outcomes for your patients.”

Dr. Patel will also be part of the interactive panel that closes out the first session of the day. “I am hopeful that the interactive panel will help stimulate a discussion about what are current gold standards and approaches to the various skin cancers being discussed, as well as practice gaps that need to be addressed,” he said. “And hopefully we can discuss what we are most excited about that is coming down the pipeline or what needs more research or to be done to take skin cancer care to the next level.” Dr. Patel added, “All practitioners have questions related to diagnosis and treatment of disease in patients with darker skin tones, and the panel provides a unique opportunity to learn how the experts manage disorders in this population.”

In the next session, Dr. Susan Taylor will speak on “Highlighting Disparities in Diagnosis and Treatment of Atopic Dermatitis, Seborrheic Dermatitis, Psoriasis, and Acne in Skin of Color Patients.” According to Dr. Taylor, common dermatology diseases that practitioners see on a daily basis may “appear differently clinically in patients with darker skin tones. This may lead to misdiagnosis and inadequate or unsuccessful treatment.” She added, “We will highlight nuances in presentation in darker skin tones and also discuss known inequalities in treatment.”

Dr. Nada Elbuluk’s presentation on “The Acne and Rosacea Skin of Color Challenge” is also on a critical aspect of dermatologic treatment options for patients with skin of color. “Acne and rosacea have unique clinical presentations in skin of color that will be discussed in this lecture,” said Dr. Elbuluk. “These unique presentations are important to consider in the evaluation and treatments of patients with these conditions.”

Session X’s interactive panel looks to be a critical component of the day. “All practitioners have questions related to diagnosis and treatment of disease in patients with darker skin tones,” stated Dr. Taylor, who will be a panelist, “and the panel provides a unique opportunity learn how the experts manage disorders in this population.”

In Session XI—The OTC Skincare Playbook, Kavita Mariwalla, MD, FAAD will present “Antioxidants and Skin Barrier Function.” He explains that “We often think of the best antioxidant as being vitamin C, but in reality, there are a number of ingredients that work as antioxidants. And the surprising thing many people don't realize is that antioxidants are not only important for people with sun damage, but can also ameliorate acne as well. Overall, antioxidant use can slow the process of inflammaging and modulate how our skin ages.”
Dr. Mariwalla also added that “Skin barrier function is implicated not only in eczema but also in rosacea and can lead to accelerated aging. Using a moisturizer in addition to antioxidants can help reduce the appearance of fine lines and wrinkles as long as the product is formulated well.”

Dr. Mariwalla is very much looking forward to the interactive panel that will close out the conference: “This panel is something I am looking forward to because we can discuss truths and myths around common over-the-counter ingredients people use. Many patients turn to social media for their information, and I think we will be able to debunk some claims that are circulating, as well as discuss new entrants in the marketplace that are exciting and will improve skin.”

Yesterday Dr. Brian Hibler presented on prejuvenation, and also ended with “Body Contouring,” 
his final presentation of the day. “Body contouring procedures have increased over 5 times in the last 8 years,” Dr. Hibler stated. “Among the most popular procedures include fat reduction with cryolipolysis and laser lipolysis, radiofrequency and microfocused ultrasound treatments, deoxycholic acid injections, and other non-invasive laser and injectable treatments of fat and cellulite.” Ultrasound treatments can be used to lift the eyebrows, improve facial lines and wrinkles, lift lax skin of the neck and below the chin, and improve lines and wrinkles of the upper chest, according to Dr. Hibler. Cryolipolysis, or using cooling to reduce fat, results in a permanent removal of approximately 20% of fat cells with each treatment and is safe in all skin types. The most commonly treated areas include the abdomen, flanks, upper arms, thighs, and below the chin.
A number of new muscle toning devices have hit the market in recent years that “utilize magnetic or electrical impulses to stimulate muscle contraction, and are being used to tone the abdomen, buttocks, thighs, and upper arms,” Dr. Hibler informed us. “There is some early evidence that these devices can result in a reduction in fat and the muscle hypertrophy may result in enhanced strength and endurance.”
Dr. Hibler included a note of caution about these procedures: “For most body contouring procedures, patients should be at or near their goal weight and lead a healthy lifestyle,” he stated. “Many of the treatments provide subtle yet noticeable results but require some work on the part of the patient to maintain and build upon the results. Patients of these procedures are more confident in their appearance and often find the results to be motivating to continue working to enhance their appearance.”

Register if you haven’t, and join us for this last set of sessions on critical topics, and don’t forget to access all sessions online here. You don't want to miss out!
—by Colleen Hutchinson

 

April 2022

Daily 3

by Colleen Hutchinson

Welcome back to Day 3 of Medscape’s second annual Innovations in Dermatology Spring Conference! Today’s agenda includes Sessions VII and VIII, Aesthetics—Facing the Future, and Aesthetics—Body of Evidence. Co-chair Dr. Michael Kaminer explained why today’s sessions are not to be missed and provide a fresh look at aesthetics. “We will be covering a wide range of practical cosmetic topics, including injectables and body treatments, which should provide a terrific foundation for dialogue and education. Even though the world shut down and/or slowed for a few years, innovation and treatments in cosmetic dermatology were surprisingly robust,” he continued. “We cover both new and updated information included in these talks, as well as some young and innovative speakers to help create lively, engaging, and educational academic sessions.”
Yesterday, Medscape featured Medical Dermatology Potpourri Parts I, II, and II. Complementing this focus was Medscape’s Keynote Presentation, “When Worlds Collide: The Intersection of Medical and Aesthetic Dermatology,” given by Dr. Michelle Henry. If you wish to access the keynote and presentations and join in virtually today and tomorrow, register here.
Read on for some insights regarding critical content being shared at today’s conference and what to expect on the final Day 4!

In Session VIII today, Dr. Jacqueline Watchmaker presents on “Nonsurgical Skin Tightening: Who, What, Where, and When.” She stated, “A number of factors contribute to skin laxity such as degradation of collagen and elastin with age, redistribution of subcutaneous fat, excessive UV light exposure, and changes in hormone levels. There are many nonsurgical skin tightening procedures available for patients today including, but not limited to, micro-focused ultrasound, radiofrequency, lasers, and a new technology called micro-coring.” She added, “In my presentation, I will talk about existing and new technologies for skin tightening and discuss ideal patient candidates for each procedure. I’ll also share videos demonstrating some skin tightening devices in action.” We look forward to it!

Dr. Kaminer shares insights from his presentation, “Combination Treatments for Targeting Cellulite,” explaining, “Our understanding of cellulite has changed over the last decade, and I’m going to present new information on where the science has taken us in terms of etiology and treatment.” He added, “Several new and exciting treatment options are now FDA cleared and available, and results are both long lasting and more impressive than ever. I plan to cover a lot of ground, summarizing 10 years of science and research in less than 30 minutes!”

Today’s offerings also include the “Demonstration Workshop: Fillers and Injections.”
Dr. Kaminer outlined what this will be: “We will demonstrate as many standard and novel injectable techniques as possible in the injectable workshop,” he promised. “By using a combination of remote video linkage and a panel of superb injectors, this dynamic session will be truly innovative.” Dr. Watchmaker added, “In the live demonstration workshop, we will discuss facial anatomy and show our approach to the cosmetic patient undergoing treatment with hyaluronic acid fillers and neuromodulators. We will showcase our personal techniques and discuss tips and tricks to optimize the patient experience and aesthetic outcome.”

Dr. Brian Hibler will present today on “Prejuvenation: Topical and Preventive Measures.” He explained prior to the conference that prejuvenation is “a preventative approach to skin aging. A good topical skin care regimen along with minimally invasive cosmetic procedures are used to prevent or delay signs of aging. Dermatologists and plastic surgeons are seeing an increasing demand for cosmetic procedures among individuals in their late 20s and early 30s. 
Social media, celebrity influence, "selfie culture", the transition to virtual meetings ("Zoom effect"), and the advent of new cosmetic devices are all fueling this increased demand.” Further, he added, “The most important skincare ingredients that should form the foundation of a prejuvenation skincare regimen include a daily, broad-spectrum sunscreen in the morning, a topical retinoid, antioxidants, and a good moisturizer. Patients seeking prejuvenation treatments wish to maintain a natural look without exaggerated changes. They desire minimally or non-invasive treatments that have little to no downtime and are safe with low risk of adverse effects.”
He explained the most popular minimally invasive cosmetic treatments for his prejuvenation population include “neuromodulators (e.g. Botox, Dysport, Xeomin, Jeuveau), dermal fillers (e.g. Restylane, Juvederm), laser treatments such as intense pulsed light (IPL) or fractional non-ablative lasers like the Clear and Brilliant laser, and ultrasound or radiofrequency devices to stimulate collagen production and provide a little lifting and tissue tightening.”
Dr. Hibler also presents today on “Body Contouring” in Session VIII.

Dr. Patricia Farris will speak on use of two treatment options in tandem—in her talk, “Integrated Skincare.” As she explains, “Integrated skincare is the use of topicals with in-office procedures.  While everyone has their favorite pre- and post-procedure products, in this talk we will take a deep dive into the science behind pairing topical skincare products with cosmetic procedures.”

In the final session of the day, Medscape presents the Demonstration Workshop: Body Contouring. Dr. Watchmaker explained, “In the live body contouring demonstration, we will discuss and show different minimally and non-invasive treatment options for body contouring. We will focus on the use of poly-L-lactic acid for volumization, collagenase for cellulite depressions and radiofrequency devices for fat reduction.” Dr. Kaminer added, “This second live session will cover several body shaping and smoothing treatments and will be one of the first of its kind at an academic meeting. I’m excited to be part of both workshops!”
Dr. Hibler is also on this panel. He looks forward to it, stating, “I anticipate having a great discussion about the approach to common body contouring concerns. We have so many new devices that have hit the market recently, and I find it helpful to hear first-hand accounts of other physicians whom I trust regarding their experiences with these devices to inform my decision on which I should consider implementing in my office. I'm always interested in hearing more about other's approaches to the patient consultation and how to gauge expectations, because patient selection is critical to optimizing results and having satisfied patients.” He added, “There are so many cosmeceutical products hitting the market! I hope to learn more from Dr. Watchmaker and Dr. Kaminer regarding any that stand out in their opinion as being essential to incorporate into a good prejuvenation regimen.”

Yesterday’s presentations shed light on several critical aspects of dermatology research and patient care. Dr. Adam Friedman presented on “The Microbiome in Acne and Rosacea” and shared takeaways: “While in recent years AD has become the poster child for the role of dysbiosis in inflammatory skin diseases, acne and rosacea should be considered the OG as microscopic bad actors as central to their pathophysiology,” Dr. Friedman shared. He added, “The latest science and understanding of how microorganisms contribute to two of the most common inflammatory skin diseases, how our current therapeutic armament can manipulate the microbial mess, and practical pearls on how to discuss with your patients were presented.”

In addition to catching the presentations, make sure to visit our interactive panels. “The best part of any lecture is the organic engagement with the audience. There are certainly more questions than answers in the world of microbiome manipulation,” opined Dr. Friedman, “but I say bring it on.” Dr. Baldwin concurred, stating, “The interactive Q&A with my colleagues is always my favorite part of conferences because this is where we can put aside data for a moment and discuss the art of practicing medicine.” Don’t miss them!

Dr. Hilary Baldwin gave the presentation “What’s New in Rosacea,” with critical new information to share. She explained, “With the brand-new benzoyl peroxide formulation for papulopustular rosacea, and recent studies that examine low dose extended-release minocycline for rosacea and the repurposing of sarecycline, this is an exciting topic to cover and one to listen to, if possible, in order to keep current.” She added that there is a lot of enthusiasm regarding the association with the comorbidity of SIBO and treatment of both conditions simultaneously with rifaximin, and that this was also touched on in her talk.

In a later session of Medical Dermatology Potpourri, Dr. Brett King presented on “Updates in Vitiligo.” There are things to look forward to regarding treatment for this condition,” explained Dr. King. “We discussed some innovative future treatments that will change the disease forever.”

IID Spring includes a first of its kind workshop for aesthetics, new developments in topical therapy for psoriasis, AD, and pediatrics, new treatments in face and body aesthetics, a skin of color dermatology spotlight, an OTC skincare playbook, today’s three medical dermatology forums, and a focus on new treatments for cutaneous malignancies. If you wish to access yesterday’s presentations for learning and join in today and this week, you can register here.

 

April 2022

Daily 2

by Colleen Hutchinson

Welcome back to Day 2 of Medscape’s second annual Innovations in Dermatology Spring Conference! Today’s agenda includes Sessions IV, V, and VI: Medical Dermatology Potpourri Parts I, II, and II. Today also encompasses Medscape’s Keynote Presentation, “When Worlds Collide: The Intersection of Medical and Aesthetic Dermatology,” given by Michelle Henry, MD, FAAD. Dr. Henry is Founder, Skin & Aesthetic Surgery of Manhattan; Clinical Instructor of Dermatology, Weill Cornell Medical College; and CEO of The Henry Research Group in New York. Welcome, Dr. Henry!
At the conference yesterday, Medscape featured many thought leaders sharing critical insights and takeaways on atopic dermatitis, psoriasis, and other conditions. Giving updates on current research and best practices, faculty brought attendees up to speed on the latest advances in patient care. If you wish to access yesterday’s presentations for learning and join in today and this week, you can register here.

If you are unable to attend in person or missed yesterday’s slate of talks, register here and take advantage of the virtual features Medscape has provided.

Read on to see the most critical content from the first day of the conference and what to expect on Day 2.

Dr. Adam Friedman is presenting on “The Microbiome in Acne and Rosacea” and Dr. Hilary Baldwin follows it up with the presentation “What’s New in Rosacea,” a topic she was glad to cover. “It’s a pleasure to be presenting this talk,” Dr. Baldwin said. “We have a brand-new benzoyl peroxide formulation for papulopustular rosacea, and there are studies examining the repurposing of sarecycline and low dose extended-release minocycline for rosacea. Lastly, the association with the comorbidity of SIBO and treatment of both conditions simultaneously with rifaximin is exciting!” 

In a later session of the Medical Dermatology Potpourri series, Dr. Brett King presents the talk, “Updates in Vitiligo.” There is quite a bit coming down the pike in terms of treatment for this condition, explained Dr. King. “We can do a lot better treating vitiligo than we are doing now, and there are innovative treatments on the horizon that are going to change this disease forever.”

Dr. King also anticipates some lively discourse in both his Interactive Q&A with Larry Eichenfield, and second Interactive Q&A with Larry and Gil Yosipovitch. “If Dr. Eichenfield notices that I am there,” he quipped, “I anticipate a riveting discussion about AA and vitiligo!”

In the final session of the day, Dr. Roxana Daneshjou presents on “Artificial Intelligence in Dermatology.” She shared, “In my presentation, we will be discussing what artificial intelligence is, and we will walk though how clinicians can evaluate papers on AI for dermatology. We will be discussing the pitfalls of AI, including the potential for bias, as well as the opportunities for AI to improve clinical workflows.” Dr. Daneshjou is looking forward to covering AI at the conference, stating, “I am incredibly excited to discuss the cutting edge of AI innovation in dermatology with the attendees, in my presentation, and also in the Interactive Panel—in which I anticipate a lively discussion about the capabilities of AI and how clinicians will interact with AI technologies in the future!”

In the first session of Day 1 of the conference, co-chair Dr. Eichenfield presented on “The Topical AD Toolbox.” He compared yesterday’s tired toolbox to the robust toolbox of today—which he likened to a “sleek, 30-drawer commercial toolbox on wheels with all kinds of new tools in it.” With 3 new drugs approved for AD in the last 4 months—and several others well on their way to approval, there is quite a bit to get current on in AD treatment. This session helped attendees with translating core studies on these drugs into “real life” clinical practice.

Dr. Peter Lio spoke on “The Evolving Landscape for Oral Systemic AD Therapies” and later, “Expert Insights in the Treatment of Warts & Molluscum Contagiosum.” On the latter, Dr. Lio shared that “Warts and molluscum are among the most common and sometimes the most frustrating things we treat, particularly in children. While we have many therapeutic choices from the past, we are on the cusp of several new therapies that may change the way we approach these common conditions.” He added, “Specifically, we addressed a new version of cantharidin with a specialized delivery device and a new topical therapy that is designed for home application for molluscum.” To register and view that presention, click here.

Dr. Eichenfield opined on the value of Dr. Lio covering these topics: “Peter Lio brings not just incredible knowledge of therapies in both these areas, but a practical approach for how to use them.” 

Co-chair Dr. Linda Stein Gold discussed new updates that attendees learned about on Day 1: “There are many new developments in topical therapy for psoriasis that were covered, inclusive of some very effective fixed combinations, including a fixed combination cream that has calcipotriene and betamethasone dipropionate, which utilizes PAD technology and shows a rapid onset of action in a very elegant cream formulation.” She continued, “We heard about the same fixed combination in a foam, which has enhanced penetration and been shown as effective as maintenance therapy. We also learned more about the fixed combination of halobetasol and tazarotene that has shown a synergistic efficacy with a very good tolerability profile.”
“Our faculty also brought us up to speed on what’s on the horizon, including two exciting non-steroidal treatments—tapinarof, which demonstrated efficacy in about 40% of patients getting to clear or almost clear after 12 weeks, and roflumilast, shown to be very effective in plaque psoriasis in cream formulation and highly efficacious for sensitive areas in skin folds. These and other treatments being studied show great promise, including an oral and a IL-17 inhibitor. One of the most valuable aspects of this meeting is the comprehensive overview of treatments for conditions we see every day. Lots to cover at this conference!”

Some takeaways from Dr. Siegfriend’s second presentation yesterday, which was “Psoriasis in Pediatric Patients,” expanded on the following: Psoriasis is a clinical phenotype. Some comorbidities are well-recognized, while others are emerging. Many factors impact optimal management. Optimal decision-making is shared (patient/provider/payer). Lastly, the therapeutic pipeline is robust. 

Dr. Stein Gold shared that in taking a holistic approach to these conditions and others, attendees can rely on this meeting to bring them up to date on what's new in medical dermatology. 

IID Spring includes a first of its kind workshop for aesthetics, new developments in topical therapy for psoriasis, AD, and pediatrics, new treatments in face and body aesthetics, a skin of color dermatology spotlight, an OTC skincare playbook, today’s three medical dermatology forums, and a focus on new treatments for cutaneous malignancies. If you wish to access yesterday’s presentations for learning and join in today and this week, you can register here.

Join us to learn this and more about critical advances in diagnosis and treatment of skin diseases to better help your patients. Don’t miss it!
by Colleen Hutchinson

 

 

April 2022

Daily 1

by Colleen Hutchinson

Welcome to Medscape’s second annual Innovations in Dermatology Spring Conference!
At the dynamic hybrid 2022 conference, faculty will share critical insights on current issues and challenges in dermatology, as well as updates on current research and best practices. This meeting will bring you up to speed on all the latest advances in patient care for you to take back to your practice. 

Just some of the learning opportunities and clinical pearls attendees can bring home from the IID Spring include an OTC skincare playbook, a first of its kind workshop for aesthetics, new developments in topical therapy for psoriasis, atopic dermatitis, pediatric treatments, new treatments in face and body aesthetics, a new skin of color dermatology spotlight, three medical dermatology forums, and a guide to new treatments for cutaneous malignancies!
If unable to attend in person, register here and take advantage of the virtual features Medscape has provided, including visiting booths in the Virtual Exhibit Hall (without having to move from your chair!), participating in peer-to-peer learning in the Virtual Poster Hall, networking with other dermatology specialists and practitioners, and accessing the virtual platform for on-demand access.

Read on to see the most critical content from the first day of the conference.

Dr. Lawrence Eichenfield co-chairs the 2022 Innovations in Dermatology Spring Conference and has planned Session I: Atopic Dermatitis Updates. He shared, “I hope our attendees know that with this agenda, what a special set of lecturers these faculty are! Katrina Abuabara does some of the most groundbreaking work on AD disease course, epidemiology work on comorbidities and some fascinating work on environmental effects. April Armstrong has incredible experience in the development and use of biologic agents, and Peter Lio always shares his incredible knowledge and guidance on practical approach to use. brings not just incredible knowledge of therapies, but a practical approach for how to use them. It should be a tremendous session.” 

Day 1’s opening session presentations include “Atopic Dermatitis: Course and Comorbidities Across the Lifespan” from Dr. Katrina Abuabara. “We used to think of atopic dermatitis just as a skin disease that mostly impacted children,” explains Dr. Abuabara. “There has been a major paradigm shift over the past decade toward our current understanding of atopic dermatitis as a systemic inflammatory condition that can impact individuals of all ages, and I'm excited to summarize what we now know and how it could impact our practice.”

Dr. April Armstrong tackles “New Data on Biologics for Atopic Dermatitis,” a critical update for all dermatologists. Also, Dr. Peter Lio speaks on “The Evolving Landscape for Oral Systemic AD Therapies” and later, “Expert Insights in the Treatment of Warts & Molluscum Contagiosum.” 

Regarding his first talk, Dr. Lio stated, “After decades of therapeutic drought for atopic dermatitis, we are now entering an era of an abundance of choices. With this comes the need to fully understand the options, their risks and benefits, and for which patients they might best be suited.” He shared that “Two new oral agents have been approved for atopic dermatitis in the United States in 2022 and we will discuss how they fit into the therapy landscape as well as discussing their use in patient care, with emphasis on patient selection and monitoring.”

Regarding “The Itch Factor” from Dr. Brian S. Kim and Dr. Brian Sudbury’s talk “AD Guidelines in Context”, he added, “Brian is one of the world’s leaders on itch, and I am itching to have him update us on the many developments in the field. Dr. Sidbury is one of the co-chairs of the AAD Guidelines Committee, which is in the midst of the update work during this time of great change in the field. He is one of our master chefs directing the production!”

Additionally in the first session of the 22nd Annual Las Vegas Dermatology Seminar, Dr. Eichenfield presents on “The Topical AD Toolbox.” 
“The toolbox of a few years ago was mostly an old-fashioned wood toolbox with some great, useful old reliable tools in it,” he shared. “In 2022, it’s a sleek, 30-drawer commercial toolbox on wheels with all kinds of new tools in it!” 

Dr. Elaine Siegfried presents in the second session with “Quick Check: Advances in Pediatric Atopic Dermatitis.” Dr. Siegfried explained, “AD is a common, often debilitating condition. Some guidance I will be sharing centers on the following pearls: Be aware of occult triggers. Include comorbidities and exacerbating factors in medical decision-making. Consider systemic therapy for moderate-severe AD. Targeted biologics have shifted the treatment paradigm. The therapeutic pipeline is robust. Case series support no apparent impact of atopy or targeted type 2 biologic treatment on COVID-19 severity. Limited data suggest no significant impact of targeted type 2 biologic treatment on vaccine response.”

Dr. Siegfried is also looking forward to the interactive panel that will follow her session. “This will be a lively discussion about evolving understanding, new treatments and real-world challenges in managing pediatric skin diseases,” she shared.

Dr. Jeffrey Sugarman presents on “Making Sense of Rare Genetic Dermatologic Disorders” in Session II. “In my session, learners will be given specific examples how discovery of the genetic underpinnings of rare skin diseases is revolutionizing our ability to treat these devastating conditions,” he explained. “Examples include nevus sebaceus with rickets, vascular malformations with overgrowth and epidermolysis bullosa.”

Dr. Peter Lio is particularly looking forward to the interactive panels following this and the first session, explaining, “I think there will be some very specific questions about how to use some of the new agents and how to counsel patients on them. I also think there is a lot of excitement about what is still in the pipeline so there may be questions about that.”

The third session of the day is The Psoriasis Forum. Led by co-chair Dr. Stein Gold, this session is a wide-ranging overview of all current treatment updates for this condition. “There are a lot of new developments in topical therapy for psoriasis to be covered,” stated Dr. Stein Gold. “I am looking forward to the exciting things we're going to see! The entire agenda is action packed. Not only is it a very comprehensive overview of what's new in psoriasis, but also of what’s new in AD.”

Join us to learn this and more about how to better care for your patients and learn about critical advances in diagnosis and treatment of skin diseases. You don't want to miss out!
—by Colleen Hutchinson
 

 

April 2022

Sneak Peek: What’s Hot at the 2nd Annual Innovations in Dermatology Spring Conference!

We’re back in your inbox this month with a special sneak peek edition of Innovations in Dermatology. We’ve got the three co-chairs and planners of Medscape’s 2022 Innovations in Dermatology Spring Conference here with us: Drs. Michael Kaminer, Linda Stein Gold, and Lawrence Eichenfeld bring a critical knowledge of current issues and challenges in dermatology, as well as pulse on current best practices, to both this interview and the conference. 
We discuss some learning opportunities and clinical pearls that attendees can bring back to their practice, including a first of its kind workshop for aesthetics, new developments in topical therapy for psoriasis, atopic dermatitis, pediatric treatments, new treatments in face and body aesthetics, a new skin of color dermatology spotlight, three medical dermatology forums, a guide to new treatments for cutaneous malignancies, and an OTC skincare playbook! Register here!
Last month, Dr. Ashfaq A. Marghoob shared new advances in diagnostics and therapeutics via the biology of skin cancers, what’s cutting edge in diagnosis and management of skin cancer and cutaneous malignancies, and pearls in the use of dermoscopy. If you missed it, you can find that interview here.
Also, don’t miss this month’s Derm Resource section that includes articles from JAMA Dermatology, Dermatology News, Cutis, and NEJM. 
Conference Deets: Innovations in Dermatology: Virtual Spring Conference 2022 is a MedscapeLIVE! event from the producers of the Hawaii Dermatology Seminar and Caribbean Dermatology Symposium. Running from April 27-30, the conference, as mentioned, is presented hybrid this year—in person and live-streamed, so you have the option of attending live at the Hilton Scottsdale, or virtually within the confines of your office or home!
Thank you to our doctors this month for giving us a sneak peek into the upcoming conference! Please contact me at [email protected] with any feedback, comments, or suggestions, and thanks again for reading.
See you in Scottsdale—online or in person!

Colleen Hutchinson

 

Sneak Peek: What’s Hot at Medscape’s 2022 Innovations in Dermatology Spring Conference 

Dr. Linda Stein Gold: Psoriasis

We are looking forward to your upcoming Medscape IID Spring presentation, Topical Psoriasis Treatment Update. What is there in the way of new updates in 2022 that attendees will learn about?
Dr. Stein Gold:
There are a lot of new developments in topical therapy for psoriasis to be covered. First, looking at what we have currently, there are some very effective fixed combinations, including a fixed combination cream that has calcipotriene and betamethasone dipropionate, which utilizes PAD technology. This medication shows a rapid onset of action in a very elegant cream formulation. We also have the same fixed combination in a foam, which has enhanced penetration and has been shown to be effective as maintenance therapy. Once patients get control of their disease after four weeks of treatments, they can begin twice weekly therapy and maintain effects. We also have a fixed combination of halobetasol and tazarotene that has shown a synergistic efficacy with a very good tolerability profile.
On the horizon, we have two very exciting non-steroidal treatments. One is tapinarof, which demonstrated efficacy in about 40% of patients getting to clear or almost clear after 12 weeks of treatment once daily. And we saw a maintenance of effect that lasted, on average, 4 months. We also have a new topical phosphodiesterase type 4 inhibitor, roflumilast, that has also been shown to be very effective in plaque psoriasis in the cream formulation and highly efficacious for sensitive areas in skin folds. Roflumilast is being evaluated in a foam formulation, which shows great promise for the scalp for both psoriasis and seborrheic dermatitis.
There are two other very exciting developments in psoriasis. One's an oral and one is IL-17 inhibitor. We have a very exciting, targeted oral drug, deucravacitinib, which is a TYK-2 inhibitor, and it is highly specific and selective for that particular JAK enzyme. It shows high efficacy in moderate to severe plaque psoriasis with a very good safety profile. We also have another exciting development with a new IL-17 inhibitor, which targets IL-17A and F. This is bimekizumab, which shows unprecedented efficacy for plaque psoriasis, also with a good safety profile. 
Lots to cover at this conference!

Dr. Michael Kaminer: Aesthetics

Colleen: Dr. Kaminer, we are very much looking forward to your Medscape IID Spring panel, Aesthetics I – Facing the Future, Parts 1 and 2, as well as Aesthetics: Body of Evidence. These are all forward-looking topics and presentations. What’s new in the way of clinical updates in 2022?
Dr. Kaminer:
Since many of us have not attended a live meeting in several years, this Medscape IID provides an opportunity to hit the reset button in terms of skills and education. We will be covering a wide range of practical cosmetic topics, including injectables and body treatments, which should provide a terrific foundation for dialogue and education.

With new topics and new presenters, it’s a very fresh look at aesthetics. What are you looking forward to among these panels?
Dr. Kaminer:
Even though the world shut down and/or slowed for a few years, innovation and treatments in cosmetic dermatology were surprisingly robust. We will have both new and updated information included in the talks, as well as some young and innovative speakers to help create lively, engaging, and educational academic sessions.

Can you tell us what to expect in the demonstration workshop?
Dr. Kaminer:
We are going to demonstrate as many standard as well as novel injectable techniques as possible in the injectable workshop. By using a combination of remote video linkage and a panel of superb injectors, this dynamic session will be truly innovative. The second live session will cover several body shaping and smoothing treatments and will be one of the first of its kind at an academic meeting. I’m excited to be part of both workshops.

Colleen: What is the scope of your presentation, Combination Treatments for Targeting Cellulite?
Dr. Kaminer:
Our understanding of cellulite has changed over the last decade, and I am going to present new information on where the science has taken us in terms of etiology and treatment.  Several new and exciting treatment options are now FDA cleared and available, and results are both long lasting and more impressive than ever. I plan to cover a lot of ground, summarizing 10 years of science and research in less than 30 minutes!

Dr. Lawrence Eichenfield: Atopic Dermatitis

Regarding your upcoming Medscape IID Spring presentation, The Topical AD Toolbox, how crowded is this toolbox in 2022? Do most clinicians across the US have easy access to the best tools we will be learning about to help their patients?
Dr. Eichenfield:
Well…the toolbox a few years ago was mostly an old-fashioned wood toolbox with some great, useful old reliable tools in it. And in 2022, it’s now a sleek, 30-drawer commercial toolbox on wheels with all kinds of new tools in it! In the last 4 months, we have had 3 new drugs approved for AD and several others well on their way to approval. And we have much to do to translate the core studies on these drugs into “real life” clinical practice, where we are assessing what might be right for each patient and working with them to make the selection and modulate the disease course. 

What are you looking forward to from Katrina Abuabara (on AD Course and Comorbidities Across the Lifespan), April Armstrong (New Data on Biologics for AD), and Peter Lio (The Evolving Landscape for Oral Systemic AD Therapies)?
Dr. Eichenfield:
I hope our attendees know what a special set of lecturers these faculty are!  Katrina does some of the most groundbreaking work on AD disease course, epidemiology work on comorbidities and some fascinating work on environmental effects. April has incredible experience in the development and use of biologic agents, and Peter always brings not just incredible knowledge of therapies, but a practical approach for how to use them. It should be a tremendous session.

Your session also features a talk titled The Itch Factor from Brian S. Kim, and AD Guidelines in Context from Robert Sidbury. These both look to be promising new presentations on timely topics for practicing clinicians who want to keep current on best practices.
Dr. Eichenfield: Brian is one of the world’s leaders on itch, and I am itching to have him update us on the many developments in the field. Rob is one of the co-chairs of the AAD Guidelines Committee, which is in the midst of the update work during this time of great change in the field. He is one of our master chefs directing the production!

 

Dermatology Resource Section:

Dermatology News Article: Trichotillomania: What you should know about this common hair-pulling disorder
https://www.mdedge.com

2nd Annual Innovations in Dermatology Spring Conference: Agenda and Register Online Here:
https://events.medscapelive.org/website/32348/home/

NEJM Article: Two Phase 3 Trials of Baricitinib for Alopecia Areata
https://www.nejm.org/doi/full/10.1056/NEJMoa2110343

Dermatology News AAD Conference Coverage: PLA testing brings nuance to the diagnosis of early-stage melanoma
https://www.mdedge.com

JAMA Dermatology Original Investigation: Analysis of Specialist and Patient Perspectives on Strategies to Improve Cardiovascular Disease Prevention Among Persons with Psoriatic Disease
https://jamanetwork.com/journals/jamadermatology/article-abstract/2787958

Cutis Clinical Review: Direct-to-Consumer Teledermatology Growth: A Review and Outlook for the Future
https://www.mdedge.com

JAMA Dermatology Editorial: Risk-Based Screening for Cancer in Patients with Dermatomyositis:
Toward a More Individualized Approach
https://jamanetwork.com/journals/jamadermatology/article-abstract/2788260

Cutis Article: The Residency Application Process: Current and Future Landscape
https://www.mdedge.com

 

March 2022

Hot Topics in Dermatology with Dr. Ashfaq A. Marghoob: What’s New in Skin Cancer

Welcome back! Innovations in Dermatology is back in your inbox this month with Dr. Ashfaq A. Marghoob sharing his thoughts on new advances in diagnostics and therapeutics via the biology of skin cancers, what’s cutting edge in diagnosis and management of skin cancer and cutaneous malignancies, and pearls in the use of dermoscopy. We also include a Rapid Fire segment with Dr. Marghoob in which he shares the most critical new advance in his area of medicine, his source for continuing education, and best tool in his clinical arsenal. Read on for more!

Last issue we featured a candid interview with some of the foremost female thought leaders in dermatology, including Drs. Mona Sadeghpour, Linda Stein Gold, Lauren Meshkov Bonati, and Shilpi Khetarpal. We discussed current barriers to success for female dermatologists, mentorship, and the true shake on female academic representation in research and publication, as well as in leadership positions in the workplace. If you missed it, you can access that interview here
This month’s Derm Resource section will keep you updated with articles from Dermatology News, JAMA Dermatology, Cutis, and NEJM

You can check out the agenda and register for the upcoming Innovations in Dermatology Spring Conference, April 27 to 30, in Scottsdale, Arizona. Presented hybrid this year, you will have the option of attending live at the Hilton Scottsdale, Scottsdale, AZ or virtually with the conference being live streamed. The four-day meeting provides interactive presentations, cases in medical dermatology, and live-patient injection sessions.

Thank you to Dr. Marghoob for his time and his critical contribution as Medscape conference faculty. Please contact me at [email protected] with comments or suggestions. Thanks for reading!

Colleen Hutchinson

 

Catching up with Ashfaq Marghoob: What’s New in Skin Cancer Diagnosis and Therapeutics

Ashfaq A. Marghoob, MD is Director of Clinical Dermatology, Memorial Sloan Kettering Skin Cancer Center.

Recently, this field has seen new insights about the biology of skin cancers. What do you find most exciting in terms of new advances in diagnostics and therapeutics that can improve diagnosis and management of skin cancer, and do you foresee overdiagnosis becoming a problem with the improvement in methods of detection?
Dr. Marghoob: Yes, this will become a bigger problem, but the real problem is not necessarily overdiagnosis but rather overtreatment. Improving our sensitivity for detecting earlier and earlier skin cancers will be accompanied by overdiagnosis. The key will be to figure out ways to differentiate the indolent from aggressive skin cancers so as to appropriately treat the aggressive ones and not overtreat the indolent ones.

Colleen: You presented at last year’s Innovations in Dermatology: Virtual Spring Conference 2021 and other meetings on “The Cutting Edge on Cutaneous Malignancies.” What was the main thrust of what you communicate on this topic?
Dr. Marghoob:
These are exciting times when it comes to diagnosis and management of skin cancer due to advances in diagnostics and therapeutics, which together have led to new insights about the biology of skin cancers. This session highlighted some key insights ranging from diagnostics to targeted and checkpoint inhibitor therapy presented by top experts in the field. Improving our methods of detection, however, may come at the price of overdiagnosis, and this concept was touched upon as well during this session. 

Colleen: What were some pearls or main takeaways from your presentation, “Presented Seeing Clearer: Dermoscopy Tips and Tricks?” 
Dr. Marghoob:
The main takeaway is to realize that dermoscopy is based on examining the lesion in two dimensions. However, the third dimension provides valuable information that can refine the differential diagnosis and improve the diagnostic accuracy. The tips and tricks in dermoscopy talk was highlighting the importance of the third dimension from correctly identifying melanin in stratum corneum versus melanin in epidermis, to making subtle sulci and comedo openings in SK more conspicuous, to correctly interpreting the fibrillar pattern in lesion on the plantar aspect of feet.

 

Rapid Fire with Dr. Marghoob:

Most critical new advance in my area of medicine: dermoscopy and confocal microscopy
Where I go for continuing education: MauiDerm, AAD
My mentor: Alfred Kopf
Advice that has helped in my career: do not settle for mediocrity
Best tool in my clinical arsenal: dermatoscope

 

Dermatology Resource Section: 

Dermatology News Article: Selling your practice
https://www.mdedge.com/dermatology/article/252788/business-medicine/selling-your-practice

Hybrid 2nd Annual Dermatology Seminar 2022: Available Online Here:
https://events.medscapelive.org/website/32348/home/

NEJM Article: Phase 2 Trial of Iberdomide in Systemic Lupus Erythematosus
https://www.nejm.org/doi/full/10.1056/NEJMoa2106535

Cutis Article: Inpatient Dermatology Consultations for Suspected Skin Cancer: A Retrospective Review
https://www.mdedge.com

JAMA Dermatology Original Investigation: Psoriasis and Cardiovascular Disease—An Ounce of Prevention Is Worth a Pound of Cure
https://jamanetwork.com/journals/jamadermatology/fullarticle/2787961

Cutis Article Clinical Review: The Impact of Prenatal Nutrition on the Development of Atopic Dermatitis in Infancy and Childhood
https://www.mdedge.com

NEJM Clinical Implications in Medicine: Cellular Memories — More Than Skin Deep
https://www.nejm.org/doi/full/10.1056/NEJMcibr2118516
 

 

February 2022

Hot Topics in Dermatology: The Status of Females in Academia

Innovations in Dermatology is back in your inbox this month with a candid interview with some of the foremost female thought leaders in dermatology. These panelists include Mona Sadeghpour, MD, Linda Stein Gold, MD, Lauren Meshkov Bonati, MD, and Shilpi Khetarpal, MD. We discuss current barriers to success for female dermatologists, mentorship, and the true shake on female academic representation in research and publication, as well as in leadership positions in the workplace.
To celebrate our first-year milestone last month, we included highlights of a few favorite clips from each issue we produced in our first year. If you didn’t get to catch this brief look back on our first year and the valuable and candid perspectives that our interview participants graciously shared with us, you can access that interview here
This month’s Derm Resource section will keep you updated with articles from NEJM, JAMA Dermatology, Cutis, Dermatology News, and more.
Thank you to all of our female thought leaders in dermatology for candidly sharing their thoughts on a hot topic for this issue.
Don’t forget to check out details here, and please contact me at [email protected] with comments or suggestions. Thanks for reading!

Colleen Hutchinson

 

Interview

Hot Topics in Dermatology: The Status of Females in Academia 
Mona Sadeghpour, MD, is a Board-Certified Dermatologist and Co-Founder of SkinMed Institute in Lone Tree, CO. 
Linda Stein Gold, MD, is Director of Clinical Research, Department of Dermatology, Detroit, and Division Head Dermatology, West Bloomfield, MI.
Lauren Meshkov Bonati, MD, is a Board-Certified Dermatologist / Cosmetic and Dermatologic Surgeon, Mountain Dermatology Specialists, Edwards, CO.
Shilpi Khetarpal, MD, is Associate Professor in Dermatology at the Cleveland Clinic Foundation, Cleveland, OH.

Colleen: What are some of the current barriers to success that female dermatologists are facing in this field? 

Dr. Mona Sadeghpour: Despite the fact that men and women have continued to apply, enter, and graduate medical school at similar rates since 2003, women continue to be underrepresented in senior and leadership positions. There are several hypotheses of why this may be occurring, including the higher attrition of women in earlier stages of their careers from the work-force due to lack of work-place support structure, inadequate mentorship, and lack of flexibility and control over work schedule, all of which would allow women to continue to advance their career during the professionally early yet personally critical time period of the child-bearing years. The perception and experience of poor work-life balance can lead to decreased sense of self-efficacy, productivity and ultimately isolation and attrition from the workplace. What is key to inspiring women to persevere and ultimately achieve a personal sense of balance, success, and professional fulfillment is a work-place leadership that cultivates a supportive work environment by establishing a culture that prioritizes mentorship and elevates and nurtures female dermatologists' talents, interests, and drive during the challenging early-career years.

Dr. Linda Stein Gold: Dermatology is a specialty that is welcoming to women.  The work/life balance is attractive, and women have found that they can be successful and still have a personal life.  Professional women, however, wear many hats.  In addition to working hard to advance their careers, many women are also the primary caretakers of their children, and in some cases, their parents.  

Dr. Lauren Bonati: Dermatology is a fantastic field for women, but the length of training, rigorous academics, and intense competition required to get there can be extremely challenging. This of course is true for both men and women, but what makes it uniquely tough for females is the timing at which these events occur. At the same time that many women are applying to residency, fellowship, or are starting their first jobs, they are also considering starting a family. Heavy external and internal pressure to stay focused on academics and career can directly conflict with ever-ticking “biologic clock” of maternal viability. Further, it can feel impossible to manage personal issues surrounding pregnancy or parenting when employers, academic departments, or colleagues are less compassionate. Dermatologists by nature are high achievers and goal-setters; no one wants a free hand-out, which makes it all the more difficult for a woman who aspires to be both Mom and dermatologist. Balancing family and career is a never-ending juggling act, but both pursuits are obviously worth the effort!

Dr. Shilpi Khetarpal: Females in the workplace are held to the same standard as their male counterparts, yet they are expected to bear and raise children, run a household and do all of their other home related tasks. The amount of pressure women feel as working mothers is immense. Many women have to either sacrifice time with their families or work part-time in order to fulfill their obligations.

Colleen: Is there enough female mentorship available for female dermatologists? 
Dr. Mona Sadeghpour:
We are lucky in dermatology to have numerous professional organizations that have implemented programs to facilitate mentorship for women. However, these programs are limited in number and funding and can sometimes be difficult to access by all the women that could benefit from them, and I think we can do better. It's important to also remember that a mentor-mentee relationship is dynamic, and its terms and needs may change over time. I personally have both male and female mentors that have and continue to help me as the landscape of my career changes. But I half-jokingly always think that I need more mentors to learn from. Continuing to examine what variables lead to a mutually successful mentor-mentee relationship, and how to increase avenues to access those relationships is critical for the future success of our field in dermatology: a field that continues to have a high representation of females in both its trainees and graduates.

Dr. Linda Stein Gold: Although males still predominate in leadership positions, we have been making great strides with female dermatologists who are thought leaders.  We see women leading meetings and featured on the podium. 

Dr. Lauren Bonati: Yes! We are lucky to be in a field where about 50% of dermatologists are women! All one has to do is look to see female leaders in academic departments, professional societies, and within the community. Strong female mentors are so important, and I’ve never known a female dermatologist, in any practice setting, to withhold her guidance when approached. There are also more formal mentorship programs available through the professional dermatologic societies, including ASDS, ASLMS, and WDS (Women’s Dermatologic Society). I am personally grateful for my experiences with the aforementioned programs and continue to speak with many of the female mentors who helped guide me through med school, residency, and fellowship. In a field that was once dominated by men, there is a special relationship between the pioneer females in our field and those they paved the way for.

Dr. Shilpi Khetarpal: Yes- unlike many other medical specialties there is a female predominance in dermatology. There is a strong culture of female mentorship and support through professional societies like the Women's Dermatologic Society.

Colleen: From an academic representation perspective, are females adequately represented in research and publication? How about in leadership positions in the workplace? 
Dr. Mona Sadeghpour:
Historically and still true to this day, women in academic medicine comprise a larger proportion of junior and early career ranks including instructor and assistant professor according to the AAMC, which has been tracking this data since the late 1960's. The data unfortunately has shown that during those critical early years, women begin to fall off the ladder at higher rates than their male counterparts and are more likely to leave academia. This leads to their lower representation at the senior ranks of associate and full professor, as well as other leadership positions including department chairs. Research, including ours in academic dermatology has shown the same trend despite the high overall representation of women in dermatology as a field. When you control for rank, however, men and women in academic dermatology are publishing and producing at similar rates. The problem is keeping young women in academia long- enough so that they can fulfill their potential. This goes back full circle to optimizing culture, support, and mentorship in the workforce that is mindful of all the forces facing and challenging young females in early stages of their career. And for those women who may find that academia may ultimately not be the place for them, mentorship by others who have been through the transition out of academia can be key in guiding them to settings where they can still fulfill their personal and professional goals.

Dr. Linda Stein Gold: The academic environment is still male dominated, but we have seen some powerful women advancing in important roles.  Dr. Emma Gutman-Yassky is now the System Chair of Dermatology and Immunology at Mount Sinai hospital, one of the most preeminent institutions in the country.  Hopefully we will see more women stepping into these important positions.

Dr. Lauren Bonati: The gender divide isn’t perfect, but it’s trending in the right direction. Historically, women have been passed over for academic promotions and female-led publications were less likely to be accepted. Even today, the majority of dermatology chairman positions are held by men. This is unfortunately true in most fields of medicine.   While chauvinistic stereotypes and gender bias certainly play a role, we cannot ignore a woman's personal preference for spending non-clinic hours in other ways, such as running a private practice, teaching residents, or conducting research - all worthwhile career-related endeavors. Family responsibilities or extracurricular hobbies may also play a role. Regardless of the reason, the balance is shifting, and we are seeing more female leaders and published authors. One thing is clear: a stronger diversity in our leadership will lead to a stronger field overall.

Dr. Shilpi Khetarpal: Dermatology is a unique field in that there are many female researchers and those in leadership positions. I am fortunate to have a female chairperson of our department who was also a recent past president of the American College of Moh's Surgery. There are female mentors, leaders and scientists in the field which serve as great examples and mentors for all of us.

 

Dermatology Resource Section: 

Dermatology News Article: The gap in cosmeceuticals education 
https://www.mdedge.com/dermatology/article/251995/aesthetic-dermatology/gap-cosmeceuticals-education

NEJM Article: A New Combination Immunotherapy in Advanced Melanoma
https://www.nejm.org/doi/full/10.1056/NEJMe2116892

Cutis Article: Concurrent Atopic Dermatitis and Psoriasis Vulgaris: Implications for Targeted Biologic Therapy
https://www.mdedge.com

JAMA Dermatology Original Editorial: Radiologic Imaging for High-Stage Cutaneous Squamous Cell Carcinomas
https://jamanetwork.com/journals/jamadermatology/article-abstract/2787677

Cutis Article Commentary: Just Like Rock and Roll, Topical Medications for Psoriasis Are Here to Stay
https://www.mdedge.com

NEJM Editorial: A New Combination Immunotherapy in Advanced Melanoma
https://www.nejm.org/doi/full/10.1056/NEJMe2116892

Dermatology News Article: Spironolactone not linked to increased cancer risk in systematic review and meta-analysis
https://www.mdedge.com

 

 

January 2022

Milestone Check: A Look Back at Year 1!

We can’t believe it, but we are celebrating one year of Innovations in Dermatology this month! What a year to begin a publication. It’s interesting to look back and recognize the numerous paradigm shifts that have taken place across different spectrums that have collectively made 2021 a year to remember in healthcare. To celebrate this milestone, we thought it would be fun to highlight a few favorite clips from each issue we produced in our first year. Interestingly, as I reviewed each issue and selected content, I realized how much the topics discussed reflect the year’s changing landscape. We hope you enjoy this brief look back on our first year and the valuable and candid perspectives that our interview participants graciously shared with us. 

Also, don’t miss this month’s Derm Resource section that includes articles from JAMA Dermatology, Dermatology News, Cutis, and NEJM
If you missed it or didn’t take part on demand, make sure to check out the Las Vegas Dermatology Seminar online to register and access this conference at your convenience.
Thank you to our readers for making this first year a successful effort! Please contact me at [email protected] with any feedback, comments, or suggestions, and thanks again for reading. 
Cheers and here’s to Year 2!

Colleen Hutchinson

 

A Look Back at Year 1: Some Favorites from 2021

Most memorable case in 2021:
Dr. Michael Kaminer: A woman in her 60s who came to see me with a face full of nodules.  She had been injected by another physician with Bellafill and developed hundreds of 3-10 mm nodules on her cheeks and chin. We have tried numerous treatment options to try and dissolve/improve the nodules, with limited success. She is incredibly sweet and grateful, but it is so difficult and frustrating to see her go through this.

Dr. Lauren Bonati: A patient came into the office with a “bruise” on her forehead that began shortly after being injected with filler in the glabella region at a local med-spa. Unfortunately, what she considered a “bruise” was a large area of necrosis overlying the suptratrochlear nerve distribution. There was not much to be done by the time she stepped into our office (2 weeks later), but it’s always an eye opener to see complications. It is a good reminder of the risks we take when performing cosmetic procedures in high-risk areas, and that only true experts should be doing these procedures. We must never underestimate the importance of mastering anatomy, using meticulous technique, and having the tools available to prevent impending complications.

Dr. Linda Stein Gold: My first case of "Covid toes" was one of my most memorable.  We were just starting to understand this condition and the association with the body's immune response to the virus.

Dr. Larry Eichenfield: An 8-year-old who presented with what looked like florid pustular psoriasis, with diffuse deeply inflamed hyperkeratotic plaques on the trunk and extremities with scattered pustules, with a history of a grandmother with psoriasis. She had a guinea pig as a pet. I initially saw her as a telemedicine consult and told her I needed to see her in person. The rash looked like psoriasis, but the brother had developed 2 inflamed lesions on the arms. The diagnosis was made on positive KOH and culture: Trichophyton mentagrophytes! Impressive tinea incognito, diffusely spread after use of potent topical steroids. The guinea pig was the culprit…they use guinea pigs in onychomycosis research because they are so easily infected with T. Mentagarophytes.

Colleen: You had stated, “Unlike the stereotype of the pimple popper that Jerry Seinfeld created, dermatologists have a lot of options for treating skin cancer in addition to surgery.” What are some of the options that may be lesser known or less relied upon, but should be more utilized?
Dr. Neal Bhatia: Dermatologists cannot allow the image portrayed by that Seinfeld episode or any other stereotype that we are just pimple poppers or glorified aestheticians. We have to be aggressive with our scope and make sure that oncologists and referring primary care physicians recognize our roles as the experts in treating skin cancer. Many of the drugs that were approved for treating actinic keratoses have been used for treating BCC, squamous cell carcinoma (SCC) in situ, and other tumors. Imiquimod is still FDA-approved for BCC, but it has not been as widely used out of lack of comfort with managing local skin reactions, and ingenol mebutate’s withdrawal from the US market has left us without a short duration treatment. It will be interesting to see if tirbanibulin is used off-label as a topical option for skin cancer despite the lack of data, and I would like to see more dermatologists becoming advocates for chemoprevention with either retinoids, nicotinamide, or photodynamic therapy, which are essential ingredients for managing the high-risk patients.

Colleen: What has been your biggest challenge in 2021?
Dr. Shilpi Khetarpal: Accommodating the large volume of patients who postponed care in 2020 due to the COVID 19 pandemic and the increasing demand for aesthetic procedures due to the "Zoom boom."

Dr. Linda Stein Gold: We have had a tremendous number of patients who put off their appointments during the pandemic. In 2021 they were ready to return to the dermatologist. I am now seeing more patients who have more serious conditions than prior years

Dr. Omar Ibrahim: My biggest challenge in 2021 has been keeping up with patient demand while balancing extracurricular commitments, society memberships/activities, and work-life balance: especially in the post-vaccine era when people have been more comfortable with in-office visits and procedures.

Colleen: Please tell us about the most current research and understanding regarding the role of collagen supplementation in skin rejuvenation.
Dr: Shilpi Khetarpal:
There is limited data supporting the use of oral collagen supplementation for skin health and rejuvenation. Once an oral supplement is ingested, it is digested by the GI tract, so very little is absorbed. Additionally, supplements can have side effects like GI upset and food allergies because the supplement industry is not well regulated and has a history of inaccurate labeling, contamination, and other safety concerns.
Rather than taking oral collagen, I recommend protecting the collagen we have by using daily SPF and topical antioxidants. We lose collagen from environmental factors like sun, cigarette smoke, and pollution causing sun damage like wrinkling, dryness, and discoloration of the skin. It is better to protect skin from sun (SPF) and pollution (antioxidants), stay hydrated, and avoid cigarettes to care for the collagen you do have, rather than trying to replenish it with supplements.

Colleen: Dr. Bhatia, you recently co-chaired the Innovations in Dermatology: Virtual Spring Conference 2021 session, “The Cutting Edge on Cutaneous Malignancies.” You commented that opportunities to maximize combinations of medical and surgical interventions, similar to oncologists, will lead to better clearance and safer alternatives for patients. You also stated that “Many patients have risks such as anticoagulants and other comorbidities, or having malignant tumors near the eyes, ears, and nose, as well as on the legs, where surgery might involve potential risks or high recurrence potential.”
What are some of the advances in topical and systemic therapies that are now safer and easier to incorporate, and that can avoid those surgical risks and/or high recurrence potential?
Dr. Neal Bhatia:
Dermatologists need to become more familiar as well as more comfortable with the potential impact of hedgehog inhibitors and checkpoint inhibitors as not only adjuncts to surgery for reducing recurrence, but also for improving surgical outcomes for larger tumors or those in areas of difficulty, such as pre-tibial areas, post-auricular, facial subunits, or other areas on the body. These therapies may require dose titration, lab monitoring, and extensive education for patients and families on potential adverse events. However, given new study data on the efficacy and safety of sonidegib and the new indication for cemiplimab for basal cell carcinoma (BCC), as well as new therapies in development such as patidegib gel, dermatologists need to be active participants and managers of these therapies or risk being marginalized as a specialty that cannot treat serious diseases.

Colleen: In a special issue of Dermatologic Surgery, you coauthored a critical review of radiofrequency microneedling (RFMN). Can you give us the main takeaways on your findings regarding the efficacy and safety of RFMN, and how it compares with other energy-based devices in a clinician's armamentarium?
Dr: Shilpi Khetarpal: RFMN is a safe, effective treatment in patients of all skin types for various indications including acne, acne scarring, hyperhidrosis, cellulite, melasma, rosacea, skin rejuvenation and striae. There is an increasing amount of evidence in the literature supporting its use with the effects being slow and progressive. It can be used independently or in combination with other treatments to improve efficacy.
Compared to other therapies, RFMN is able to go deeper than lasers and, given that it only heats the dermis, it is safe in all skin types. There are numerous devices on the market that vary in terms of needle depth, insulation, number, and pulse duration. Not all devices are equal, so it is important to counsel patients accordingly. 

Colleen: Can you give us some insights from your latest article in The Journal of the American Academy of Dermatology (JAAD), “The effects of neurotoxin and soft tissue fillers on gender perception in transgender individuals: A pilot prospective survey-based study”?
Dr. Lauren Bonati: While surgery has long been the mainstay of treatment for gender dysphoria in transgender individuals, our new research shows that injectables may play a role for those who are not yet ready or able to pursue more invasive solutions. After treating 9 transgender individuals with neurotoxin and soft tissue fillers, pre and post treatment surveys showed that even small changes in physical appearance improved quality of life and self-perceived gender perception in all subjects. This is the first study of its kind to show quality of life benefits associated with injectable treatments in this patient population.
Although results were encouraging, it was a small study with limited follow-up. In real life clinic, patients should be counseled that injectables are expensive, not covered by insurance, and may not yield the dramatic results of gender affirmation surgery and hormonal therapy. Noninvasive treatments should be viewed as an adjunct, not a monotherapy. It is our hope that this study will spur others on to both do more research and continue treating transgender patients.
 
Colleen: How would you characterize the evolution of industry’s role as a partner in dermatology education and research and what it is today?
Dr. Jeremy Green:
My partners and I conduct clinical trials in both aesthetic and medical dermatology. Our intellectual curiosity has also lead us to self-fund small projects. While very rewarding, the costs involved (IRB, staffing, product, our time, etc.) remind me that if it was solely up to busy practicing dermatologists to innovate, our field would be running in quicksand. With its considerable resources, industry is an absolutely essential partner for advancement in dermatology. It's a symbiotic relationship that for the most part enhances our ability to care for patients.

Dr. Linda Stein Gold: I see industry as a true partner with the dermatology community.  We have seen an explosion of new technology with targeted treatments, and much of this research has come from industry. With our increased understanding of the pathogenesis of diseases, such as atopic dermatitis and psoriasis, industry has taken a lead in educating the dermatology community on the new developments.

Colleen: What are one or two pearls that attendees should come away with and be able to translate to practice from your upcoming presentations at the LVD Seminar 2021?
Dr. Neal Bhatia:
Some pearls from my first presentation on proper treatment of actinic keratosis and optimizing topical treatments are: 1) have patients fill prescriptions between Monday and Thursday, as then it is less likely to be switched than on Fridays or weekends. 2) Have patients start treatments on Sundays so that reactions occur mid-week rather than on weekends. 3) Do not shortchange freezing times with cryo just like incubation with PD—Make the patients do the time especially for extremities. 4) Anticipated local skin reactions are not side effects—Be a cheerleader for the outcomes!
Another set of pearls from my presentation on topical treatments for warts to reduce recurrence and optimize clearance are: 1) Same destructive and immune-based therapies approved for AKs have been studied off-label for warts. 2) Costs, tolerability, and compliance are all limiting factors. 3) Summaries of combination studies with cryo for warts are incomplete unless studied against topical therapies alone.

Colleen: What was the best source of education for you this year?
Dr. Michael Kaminer:
Virtual educational sessions have dramatically expanded and are a convenient tool for staying informed and up to date. I also worked on several virtual Medscape meetings which provided a ton of valuable educational content. We also started a virtual Journal Club at Skincare Physicians, which has been a terrific opportunity to stay current, as well as stay connected to colleagues.

Dr. Lauren Bonati: I was in the first cohort of candidates to take the American Board of Dermatology’s Mohs Micrographic Surgery board exam. As such, I did a lot of reading, studying, and microscope work in preparation. A big part of my studying was staying up to date on all the recent articles and trials which have pushed our field forward. There’s nothing like studying for a huge exam to make you feel at the top of your game!

Dr. Larry Eichenfield: I would have to say a mix of the fabulous virtual conferences that I’ve had the pleasure of lecturing at and attending, and the few “live meetings” that allowed more social interaction as well as education.  No one favorite, but I have listened to superb lectures and great question and answer sessions that really allowed me to broaden my clinical knowledge in an easy and enjoyable way.  A shout out to the Medscape Innovations meetings, which were fun to be part of and brought in an engaged audience of learners.

Dr. Shilpi Khetarpal: Virtual meetings were excellent, including the AAD and ASDS meetings. It's always nice to hear about new trends in dermatology and to have these resources on demand, and to be able to access them from home was great!

Colleen: Dr. Bellew, what are one or two pearls that attendees will come away with and be able to translate to practice from your presentation, Giant Basal Cell Carcinoma, at the LVD Seminar 2021?
Dr. Jonathan Bellew:
Basal cell carcinoma is the most prevalent cancer in human beings. As dermatologists, we encounter basal cell carcinomas on an almost daily basis in our clinical practice. I wanted this case to highlight the aggressive nature of this rare subtype of basal cell carcinoma and stress the importance of continued monitoring of our skin cancer patients to prevent these lesions from reaching a size that may cause significant morbidity. I also wanted to highlight the nature of interaction between physicians and patients that are hesitant to seek medical attention until their medical condition is significantly advanced. In my patient’s case, she had left her skin cancers for many years before seeking treatment due to a fear of the medical profession and bad experiences with physicians in the past. 

 

Dermatology Resource Section: 

Dermatology News Article: FDA approves risankizumab (Skyrizi) for psoriatic arthritis
https://www.mdedge.com

Virtual 22nd Annual Las Vegas Dermatology Seminar 2021: Available Online Here:
https://na.eventscloud.com/website/27164/agenda/

NEJM Article: Trial of Spesolimab for Generalized Pustular Psoriasis
https://www.nejm.org/doi/full/10.1056/NEJMoa2111563

Cutis Article: The Leaky Pipeline: A Narrative Review of Diversity in Dermatology; In Collaboration With the Skin of Color Society
https://www.mdedge.com

JAMA Dermatology Original Investigation: Association Between Atopic Dermatitis and Height, Body Mass Index, and Weight in Child
https://jamanetwork.com/journals/jamadermatology/article-abstract/2785896

Dermatology News Article: Should you dismiss that patient?
https://www.mdedge.com/dermatology/article/250814/business-medicine/should-you-dismiss-patient

Cutis Article Commentary: Teledermatology During the COVID-19 Pandemic: Lessons Learned and Future Directions
https://www.mdedge.com

NEJM Editorial: A New Combination Immunotherapy in Advanced Melanoma
https://www.nejm.org/doi/full/10.1056/NEJMe2116892

 

 

December 2021

Looking Back on 2021: A Year in Review 

Welcome back! Innovations in Dermatology is back in your inbox this month with Drs. Shilpi Khetarpal, Michael Kaminer, Omar Ibrahim, Neal Bhatia, Linda Stein Gold, Lauren Bonati, and Larry Eichenfield. These thought leaders collectively look back on the past year and its challenges and highlights. We thank them for their time and their candor, especially insharing their most challenging and memorable cases of 2021. 
Last month, Dr. Jonathan Bellew shared his thoughts on the recent virtual 22nd Annual Las Vegas Dermatology Seminar. If you missed it, you can find that interview here. You can also still register here to access the conference, obtain CME, and get current on the latest research and treatment options in medical dermatology and aesthetics.

This month’s Derm Resource section will keep you updated with articles including a JAMA Dermatology Original Investigation from Dr. Bruce Strober and colleagues just released this week, and December articles from Dermatology News, Cutis, and NEJM
Also, make sure to check out the Suggested Reading from Dr. Ibrahim, and the Linked In Live Las Vegas Dermatology Seminar Preview - MedscapeLIVE! This is a short video I moderated with a few faculty who share some pearls from their upcoming presentations at the Las Vegas Dermatology Seminar. To view that brief roundtable online, click here
Thank you to our participants for their time and also their continuing critical contributions as thought leaders and as conference faculty. Please contact me at [email protected] with comments or suggestions, and thanks for reading. Happy New Year!!

Colleen Hutchinson

 

Interview

Looking Back on 2021: A Year in Review

Colleen: What was your most memorable case or patient in the last year and why?
Dr. Michael Kaminer:
A woman in her 60s who came to see me with a face full of nodules.  She had been injected by another physician with Bellafill, and developed hundreds of 3-10 mm nodules on her cheeks and chin. We have tried numerous treatment options to try and dissolve/improve the nodules, with limited success. She is incredibly sweet and grateful, but it is so difficult and frustrating to see her go through this.

Dr. Omar Ibrahim: My most memorable case involved a young refugee from Afghanistan who had suffered from facial leishmaniasis that left significant scarring in its wake. Not only was it difficult for him to adjust in the US due to being a recent immigrant, but the scars on his face made him more self conscious and reclusive. After a series of pro bono non-ablative and ablative laser procedures, the scars improved significantly, and the patient admitted that he now goes out, has friends, and even has a girlfriend.

Dr. Linda Stein Gold: My first case of "Covid toes" was one of my most memorable.  We were just starting to understand this condition and the association with the body's immune response to the virus.

Dr. Larry Eichenfield: An 8-year-old who presented with what looked like florid pustular psoriasis, with diffuse deeply inflamed hyperkeratotic plaques on the trunk and extremities with scattered pustules, with a history of a grandmother with psoriasis. She had a guinea pig as a pet. I initially saw her as a telemedicine consult, and told her I needed to see her in person. The rash looked like psoriasis, but the brother had developed 2 inflamed lesions on the arms. The diagnosis was made on positive KOH and culture: Trichophyton mentagrophytes! Impressive tinea incognito, diffusely spread after use of potent topical steroids. The guinea pig was the culprit…they use guinea pigs in onychomycosis research because they are so easily infected with T. Mentagarophytes.

Dr. Neal Bhatia: Of all of the patients seen in 2021, the most memorable was an Asian male with horrible psoriasis that had only been treated with Vaseline and, after we finally got him onto biologics and on a routine of skin care, has a brand new life both personally and professionally.  It sounds simple, and yet we still have a huge gap in the use of biologics and systemic therapies in dermatology…another reminder that there is a huge cost to NOT treating patients in a world where everyone is fixated on the costs of drugs

Dr. Shilpi Khetarpal: I had a young patient with severe hair loss. After 6 months of a customized medical treatment plan and platelet rich plasma (PRP) injections, she was able to stop wearing her hair piece and went on a date for the first time in 5 years. She said her hair regrowth “changed her life.”

Dr. Lauren Bonati: A patient came into the office with a “bruise” on her forehead that began shortly after being injected with filler in the glabella region at a local med-spa. Unfortunately, what she considered a “bruise” was a large area of necrosis overlying the suptratrochlear nerve distribution. There was not much to be done by the time she stepped into our office (2 weeks later), but it’s always an eye opener to see complications. It is a good reminder of the risks we take when performing cosmetic procedures in high-risk areas, and that only true experts should be doing these procedures. We must never underestimate the importance of mastering anatomy, using meticulous technique, and having the tools available to prevent impending complications.

Colleen: What has been your biggest challenge in 2021?
Dr. Khetarpal:
Accommodating the large volume of patients who postponed care in 2020 due to the COVID 19 pandemic and the increasing demand for aesthetic procedures due to the "Zoom boom."

Dr. Bhatia: My biggest challenge at work was balancing the workload with my duties as AAD Vice President, navigating through the shortage of trials starting in the pandemic, and trying to get patients to come back to get checked…and of course my challenge at home was the struggle to still fit into my clothes.

Dr. Kaminer: Clearly Covid, and particularly staffing related to Covid. The paradigm has shifted, and keeping staff happy, as well as bringing on new staff to work face to face with colleagues and patients is a meaningful challenge.

Dr. Stein Gold: We have had a tremendous number of patients who put off their appointments during the pandemic. In 2021 they were ready to return to the dermatologist. I am now seeing more patients who have more serious conditions than prior years

Dr. Ibrahim: My biggest challenge in 2021 has been keeping up with patient demand while balancing extracurricular commitments, society memberships/activities, and work-life balance: especially in the post-vaccine era when people have been more comfortable with in-office visits and procedures.

Dr. Eichenfield: The continuation of COVID, with a pattern of “well, it looks like this is settling down,” followed by “wait, maybe not yet.”  Our volume of patients is at record levels, but our usual communal sensibility of team care is still restricted, with educational conferences and meetings being on Zoom, vs. in person.

Dr. Bonati: The uncertainty of COVID-19 made this past year difficult. With continuously changing guidelines on how to best protect our staff and patients, it was a stressful time for everyone. Luckily, I have a great patient base and excellent staff who prioritize protecting each other by wearing masks, social distancing, getting vaccinated, and staying home when sick!

Colleen: What was the best source of education for you this year?
Dr. Kaminer:
Virtual educational sessions have dramatically expanded, and are a convenient tool for staying informed and up to date. I also worked on several virtual Medscape meetings which provided a ton of valuable educational content. We also started a virtual Journal Club at Skincare Physicians, which has been a terrific opportunity to stay current, as well as stay connected to colleagues.

Dr. Bonati: I was in the first cohort of candidates to take the American Board of Dermatology’s Mohs Micrographic Surgery board exam. As such, I did a lot of reading, studying, and microscope work in preparation. A big part of my studying was staying up to date on all the recent articles and trials which have pushed our field forward. There’s nothing like studying for a huge exam to make you feel at the top of your game!

Dr. Ibrahim: The best sources of education have been the virtual conferences and meetings; although the pandemic has brought in-person meetings to a standstill, the conversion to virtual meetings has allowed me to keep up with my education, and I hope virtual options for meetings are here to stay.

Dr. Eichenfield: I would have to say a mix of the fabulous virtual conferences that I’ve had the pleasure of lecturing at and attending, and the few “live meetings” that allowed more social interaction as well as education.  No one favorite, but I have listened to superb lectures and great question and answer sessions that really allowed me to broaden my clinical knowledge in an easy and enjoyable way.  A shout out to the Medscape Innovations meetings, which were fun to be part of and brought in an engaged audience of learners.

Dr. Khetarpal: Virtual meetings were excellent, including the AAD and ASDS meetings. It's always nice to hear about new trends in dermatology and to have these resources on demand and to be able to access them from home was great!

Dr. Bhatia: The return of live meetings and getting back to business was by far the best surge for motivation for education.  Webinars and virtual learning can vanish for all I care, screen fatigue is too much to overcome.  We need to be back in the same room talking and teaching each other.

Dr. Stein Gold: I have really enjoyed the combination of virtual and the return to in-person learning.

Suggested Reading

Article: Platelet-rich Plasma, Collagen Peptides, and Stem Cells for Cutaneous Rejuvenation. Wang JV, Schoenberg E, Saedi N, Ibrahim O. J Clin Aesthet Dermatol. 2020 Jan;13(1):44-9.
https://pubmed.ncbi.nlm.nih.gov/32082473/
 
Dr. Ibrahim: The use of platelet-rich plasma, collagen supplementation and stem cells is rapidly expanding and evolving. This article reviews the current evidence, or lack thereof, of these treatment modalities, and is a helpful resource for clinicians that use these therapies in their practice.

 

Dermatology Resource Section: 

Virtual 22nd Annual Las Vegas Dermatology Seminar 2021: Available Online Here:
https://na.eventscloud.com/website/27164/agenda/

JAMA Dermatology Original Investigation: Treatment Outcomes Associated With Dupilumab Use in Patients With Atopic Dermatitis1-Year Results From the RELIEVE-AD Study
https://jamanetwork.com/journals/jamadermatology/newonline/2021/12

Dermatology News Article: Moisturizers and skin barrier repair
https://www.mdedge.com/dermatology/article/249855/aesthetic-dermatology/moisturizers-and-skin-barrier-repair

Cutis Article: Proper Use and Compliance of Facial Masks During the COVID-19 Pandemic: An Observational Study of Hospitals in New York City
https://www.mdedge.com/

NEJM Article: Phase 3 Trials of Tapinarof Cream for Plaque Psoriasis
https://www.nejm.org/doi/full/10.1056/NEJMoa2103629

Innovations in Dermatology Virtual Spring Conference 2021: Available Online Here: https://na.eventscloud.com/website/20848/

 

 

November 2021

Looking Back on LVD2021! 

Welcome back! Innovations in Dermatology is back in your inbox this month with Dr. Jonathan Bellew sharing his thoughts on the recent virtual 22nd Annual Las Vegas Dermatology Seminar, which was November 10-14. You can still register to access this innovative conference and obtain CME and get current on the latest research and treatment options in medical dermatology and aesthetics.
In last month’s issue, we featured a faculty group panel opining on what’s hot at the conference. If you missed it, you can find that interview here
This month’s Derm Resource section will keep you updated with articles from Dermatology News JAMA, Cutis, and NEJM and a CME/CE Certified Supplement from the Hawaii Dermatology Seminar. 
Also, make sure to check out the Linked In Live Las Vegas Dermatology Seminar Preview - MedscapeLIVE! This is a short video I moderated with a few faculty who share some pearls from their upcoming presentations at the Las Vegas Dermatology Seminar. To view that brief roundtable online, click here
Thank you to Dr. Bellew for his time and also his critical contribution as conference faculty. Please contact me at [email protected] with comments or suggestions. Thanks for reading!

Colleen Hutchinson

 

Interview

Looking Back on LVD 2021! An Interview with Jonathan Bellew, DO
Jonathan Bellew, DO, is Owner of The Skin Docs dermatology group, Las Vegas, Nevada.

Colleen: Dr. Bellew, what are one or two pearls that attendees will come away with and be able to translate to practice from your presentation, Giant Basal Cell Carcinoma, at the LVD Seminar 2021?
Dr. Bellew:
Basal cell carcinoma is the most prevalent cancer in human beings. As dermatologists, we encounter basal cell carcinomas on an almost daily basis in our clinical practice. I wanted this case to highlight the aggressive nature of this rare subtype of basal cell carcinoma and stress the importance of continued monitoring of our skin cancer patients to prevent these lesions from reaching a size that may cause significant morbidity. I also wanted to highlight the nature of interaction between physicians and patients that are hesitant to seek medical attention until their medical condition is significantly advanced. In my patient’s case, she had left her skin cancers for many years before seeking treatment due to a fear of the medical profession and bad experiences with physicians in the past. 

Colleen: What is one of the most recent new treatment options that can be adopted to your practice that you find most valuable?
Dr. Bellew:
I am fascinated by the speed with which new psoriasis treatments have transformed how we treat this ancient and difficult skin disease. Ten years ago, we had a handful of options for our most challenging psoriatic patients. Now we have sophisticated and targeted biologic agents that block key interleukins involved in the psoriatic immune pathway. My hope is that other difficult to treat skin diseases such as atopic dermatitis, vitiligo, and the vesiculobullous disorders will see advances in treatment options during the next decade that will allow us as clinicians to better treat our patients.

Colleen: Within the same session Medical Dermatology Part 2, different cases were presented (Best Cases of Las Vegas 2021, Great Cases from the Las Vegas Dermatology Society, and Case Presentation: Acquired Ichthyosis). Is the sharing of these cases very valuable to attendees? Were there any that you found to be valuable in particular?
Dr. Bellew: The sharing of these cases is vital to the future of medicine as we, as clinicians, can learn so much from our colleagues about not only the approach to rare and difficult cases, but how to incorporate new therapies or approaches to treatment into our treatment algorithm.

Colleen: What other presentations did you find particularly valuable to hear?
Dr. Bellew:
I very much enjoyed Dr. Callen’s lecture about the effects of JAK inhibitors in dermatology, as I feel these are the next great agents to affect a multitude of difficult to treat skin disorders, such as vitiligo, alopecia areata, sarcoidosis, and dermatomyositis.

Colleen: How have you adapted to COVID in terms of major changes within your practice? Are these changes here to stay?
Dr. Bellew:
I opened my practice in July 2020, at the height of the pandemic in Las Vegas, Nevada. We are a tourist town with many visitors from throughout the United States and internationally. Before opening my doors in July 2020, I planned my clinic layout to provide for social distancing in our lobby and installed hand sanitizers at check-in, check-out, and in each patient room. I also used this time to educate my employees and patients about the importance of hand washing and sterile techniques to avoid not only the spread of the coronavirus, but all potential microorganism threats, including other viruses, bacteria, parasites, and fungi. I think that physicians should be the leaders in this realm, as our training and education has prepared us to be the authority in directing and educating public health. I believe these changes are valuable in preventing the infectious spread of microorganisms and the next pandemic.

 

Dermatology Resource Section: 

Innovations in Dermatology Virtual Spring Conference 2021: Available Online Here: https://na.eventscloud.com/website/20848/

Dermatology News Article: Improving statewide reporting of melanoma cases
https://www.mdedge.com/dermatology/article/248871/melanoma/improving-statewide-reporting-melanoma-cases

Cutis Article: Advocacy Update: Is Your Practice Equipped to Handle Looming Changes in Dermatopathology?
https://www.mdedge.com/dermatology/issue/248257/cutis-1085

NEJM Article: Regulating Drug Prices while Increasing Innovation
https://www.nejm.org/doi/full/10.1056/NEJMp2113764

Medscape CME—Filler Workshop: Injection Session Video 1—
A CME/CE Certified Supplement from the Hawaii Dermatology Seminar
https://www.globalacademycme.com

JAMA Dermatology Original Investigation: Association Between Atopic Dermatitis and Height, Body Mass Index, and Weight in Children
https://jamanetwork.com/journals/jamadermatology/article-abstract/2785896

 

November 2021

Daily – Session 5 Ask Kaminer, Green, 

During past few days, we’ve been treated to excellent coverage and updates on treatment innovations for some of the most challenging skin conditions and cases at Medscape’s 22nd Annual Las Vegas Dermatology Seminar. We hope you’ve been able to view these presentations this week live, but if not, go online and register here to view any and all sessions of the conference. 
As a virtual attendee, you can take advantage of robust opportunities to interact with colleagues beyond the educational sessions. Please take full advantage of the virtual conference features that Medscape has provided, including visiting booths in the Virtual Exhibit Hall (without having to move from your chair!), participating in peer-to-peer learning in the Virtual Poster Hall, networking with other dermatology specialists and practitioners, and accessing the virtual platform for on-demand access until January 2022.
Read on to see the most critical content from the first session of the conference.
Also, don’t miss the conference co-chairs discussing this conference (and sharing some pearls from their upcoming presentations) in this short video, Linked In Live Las Vegas Dermatology Seminar Preview - MedscapeLIVE! To view that brief roundtable online, click here!

Dr. Michael Kaminer is chairing Medscape’s Sunday Day 5 of the LVD Seminar—Aesthetics. I asked Dr. Kaminer what attendees will be learning regarding injecting techniques with neuromodulators, to which he answered, “The world of aesthetics has greatly evolved, both in general dermatology and specifically within aesthetic medicine. What's interesting regarding neuromodulators is some of the evolution of neuromodulators that's starting to trend toward more natural results.”
He continued, “You might think, we've been producing natural results for years. But the reality is we've all seen people in media and in person who look overdone and overfrozen. And that's not an accident. Those outcomes happen for a reason. But are beginning to better understand why people look overdone. So in this session, we give a lot of time to the question: How do you make people look natural? Predictably, we'll also talk about some of the new neuromodulators that might be coming—and there are a lot of interesting developments right now in neuromodulators to discuss. We can really all learn from this session’s focus given what’s on the horizon and it will be extremely valuable to attendees.” 

Dr. Jeremy Green presents on “The Art of Injection: Techniques Using Neuromodulators” and  “Skin Rejuvenation: Ablative and Non-Ablative Lasers” and shared some perls with us prior to the live talks:
 
“One of my favorite pearls that I’ll share in my first talk is the 3-point glabellar frown line neuromodulator technique I’ve been using for about 2 years now every day I practice,” shared Dr. Green. “It is a very powerful technique that has allowed me to improve my treatments for patients with larger muscle mass and those who I might have shied away from injecting previously. It is not without its pitfalls, however, and I share those in my lecture as well.”
 
On his second presentation, “Skin Rejuvenation: Ablative and Non-Ablative Lasers,” Dr. Green added, “I discuss a couple of my favorite combos with resurfacing lasers, first combining pigment specific lasers with the 1927nm thulium laser in the same session. I also share how I combine lasers and neuromodulators for optimal results in the face.”

Another hot topic to be covered is developing and utilizing a targeted approach to addressing cellulite. I asked Dr. Kaminer what the most important advice is that he can give practicing dermatologists today regarding this. 

“This is near and dear to my heart,” Dr. Kaminer explained, “because I've done a lot of work in the research side of it. But the bottom line is this is not your grandmother's cellulite anymore. We now understand a lot better what cellulite looks like, what causes it, and—importantly, how to treat it. In addition to that, we now have multiple FDA approved treatment options for cellulite. So we'll talk a lot about the nuances of cellulite, what differentiates one kind from another, etc.

“We also discuss how you tailor a treatment regimen to a patient and, importantly, how to give results that patients are satisfied with and will last for years and years,” he added. “We have a lot of options for this goal, and we'll talk in detail about how those options can be fit for each individual patient to give him or her lasting satisfaction.”

You can register and access these and all Day 5 presentations here. Also, add to your calendars both of the Aesthetics live interactive Q&A panels, first at 11:00am EST with Drs. Omer Ibrahim, Michael Kaminer, and Jeremy Green, and the second one to conclude the session and the conference at 12:50pm EST with Drs. Omer Ibrahim, Michael Kaminer, Jacqueline Watchmaker, and Jeremy Green.

Register if you haven’t, and join us for this last session on aesthetics, and don’t forget to access all sessions online here. You don't want to miss out!
—by Colleen Hutchinson

 

November 2021

Daily – Session 4: Psoriasis Forum

Welcome to Thursday’s Day 4 session of Medscape’s virtual 22nd Annual Las Vegas Dermatology (LVD) Seminar! If you missed Day 1 or Day 2 sessions, make sure to circle back and check it out here. 
During this Day 4 Psoriasis Forum session, chaired by Dr. Francisco A. Kerdel, several thought leaders including Drs. Linda Stein Gold, Bruce Strober, and Kenneth Gordon bring us up to speed on new research and promising treatments for this common condition that are on the horizon. Read on to see the most critical content from yesterday’s session plus what will be highlighted in today’s Day 4 session. 
Colleen Hutchinson 

Dr. Bruce Strober underscored the importance of having a full-day session on psoriasis. “LVD is an in-depth, clinically relevant update on psoriasis therapies. Presented are the most recent data along with advanced therapy pearls,” he stated.

Regarding the interactive panel that rounds out Day 4 with Drs. Francisco Kerdel, Kenneth Gordon, and Linda Stein Gold, Dr. Bruce Strober shared why these panels are so valuable for everyone—including the panelists themselves. “Only through discussion, prompted by Q&A, do we flesh out clinically challenging treatment scenarios, and bring to bear all the prodigious experience of the panelists on issues that face our patients.” Dr. Linda Stein Gold echoed this, explaining, “The psoriasis panel provides a platform for great discussion and debate regarding treating complicated patients. I enjoy hearing the different perspectives.”

Dr. Strober’s said of his presentation, “Novel Pathways: IL-12/23 and IL-23 Inhibitors,”  “While having robust efficacy for the skin, IL-23 inhibitors have respectable effectiveness for psoriatic arthritis, and could be used as first-line therapies for psoriasis patients with mild psoriatic arthritis.”
He also presents on “Small Molecules for the Systemic Treatment of Psoriasis.” “Deucravacitinib,” Strober explained, “a once daily, oral small molecule selective inhibitor of TYK2, combines strong efficacy with good safety, and likely does not require laboratory monitoring. Apremilast will be the first systemic drug approved for mild-to-moderate psoriasis.” For this and more on these presentations, tune in here.

Don’t forget that as a virtual attendee, you can network with colleagues beyond the educational sessions, visit booths in the Virtual Exhibit Hall right from your desk, experience peer-to-peer learning in the Virtual Poster Hall and access the virtual platform for on-demand access until January 2022. Register here!

Join us tomorrow as well for Day 5 Aesthetics. Dr. Jeremy Green presents on ablative and non-ablative lasers, and injection techniques using neuromodulators, as well as serves as a panelist at 11am EST with Drs. Omer Ibrahim and Michael Kaminer. Echoing what we heard from Drs. Strober and Stein Gold about the value of panels, Dr. Green stated, “These panels are so important because when we lecture we present the general principles we use in daily practice, but the interactive panel allows us to share nuances of what we do that are sometimes difficult to bring out in a timed/structured lecture. I personally have learned so much from my fellow speakers in these settings.”

by Colleen Hutchinson

Also, don’t miss the conference co-chairs discussing this conference (and sharing some pearls from their upcoming presentations) in this short video, Linked In Live Las Vegas Dermatology Seminar Preview - MedscapeLIVE! To view that brief roundtable online, click here!

 

November 2021

Daily – Session 3

Welcome to Thursday’s Day 3 session of Medscape’s virtual 22nd Annual Las Vegas Dermatology Seminar! If you missed Day 1 or Day 2 sessions, make sure to circle back and check it out. 
During Medscape’s dynamic virtual Session 3 Atopic Dermatitis Forum at the 22nd Annual Las Vegas Dermatology Seminar, moderated by Dr. Linda Stein Gold, several thought leaders will be sharing critical insights on the pathogenesis and treatment of atopic dermatitis. Read on to see some future highlights in the third session of the conference and some from Day 2’s session as well.
Colleen Hutchinson 

Yesterday’s Day 2 presentations included “Giant Basal Cell Carcinoma” from Las Vegas dermatologist Dr. Jonathan Bellew. He shared four critical points that were expounded on in his talk:

  1. Giant basal cell carcinoma is defined as greater than 5.0 centimeters in diameter.
  2. Only 1% of all basal cell carcinomas reach this size.
  3. It is a rare and aggressive skin cancer with a high rate of recurrence.
  4. Long-term follow-up for life is recommended due to a high rate of locoregional recurrence.

To see the rest of Dr. Bellew’s presentation and hear more on each of these pearls, register here and access it!

Dr. Joe Fowler contributed two highly anticipated presentations on Day 2 as well, titled “Atopic Dermatitis - Don't Forget the Skin Barrier” and “New Oral Agents for Atopic Dermatitis.” Dr. Fowler shared that, “While there are a load of new drugs targeting the immune system in AD, we need to remember that the defective skin barrier is still an important part of the disease.” He expounds on this in his talk, giving more specific guidance on the topic. In addition, he explained that there is promise in what’s in the pipeline for AD, explaining, “JAK inhibitors for AD are on the horizon and may revolutionize AD treatment for some patients.” To learn more, go online to view these presentations in full. 
In addition, don’t miss the Day 3 interactive panel at 3pm EST: “In this Atopic Dermatitis Q&A panel,” said Dr. Fowler, “we'll have a lively discussion of the pros and cons of newer and older therapies. Don’t miss it!”

Dr. Eichenfield presented yesterday on “Life-Threatening Pediatric Dermatoses.” He explained that the central question is: "Is that child’s condition an emergency?”  He will share insights and presented “a set of challenging cases and differential diagnoses, with the hope of engaging attendees to consider What is it? How do I evaluate it? How do I treat it?”  Dr. Eichenfield added, “Working through some cases and hearing about state-of-the-art management of some worrisome conditions should help us improve our clinical acumen and increase our comfort caring for children and adolescents.” 

Look to hear Dr. Eichenfield speak as well on Day 3 on what’s often asked when it comes to AD in his presentation, “5 FAQs in Atopic Dermatitis.”  He explains why this talk is valuable to any dermatologist because they all are fielding questions on this topic. “Atopic dermatitis can be such a challenge to manage, especially with so many concerns and issues brought to the office by patients and families,” he explained. “I will be discussing five frequently asked questions about AD and its management, my thoughts and answers to these interesting queries, and in the process, reviewing evolving perspectives and treatments of eczematous dermatitis.”

Remember—As a virtual attendee, you can take advantage of robust opportunities to interact with colleagues beyond the educational sessions. Please take full advantage of the virtual conference features that Medscape has provided, including visiting booths in the Virtual Exhibit Hall (without having to move from your chair!), participating in peer-to-peer learning in the Virtual Poster Hall, networking with other dermatology specialists and practitioners, and accessing the virtual platform for on-demand access until January 2022.

by Colleen Hutchinson

Don’t Miss: 

Access the conference co-chairs discussing this conference (and sharing some pearls from their upcoming presentations) in this short video, Linked In Live Las Vegas Dermatology Seminar Preview - MedscapeLIVE! To view that brief roundtable online, click here!

 

November 2021

Daily – Session 2

by Colleen Hutchinson

Welcome to Thursday’s Day 2 of the Medical Dermatology portion of Medscape’s virtual 22nd Annual Las Vegas Dermatology Seminar! If you missed Day 1 yesterday, make sure to circle back and check it out. The Chair of yesterday’s session, Dr. Joseph Fowler, explained, “Each day of this conference will provide up-to-the minute information on the newest treatments in medical dermatology.” 
During Day 1 on Wednesday, Dr. Fowler oversaw faculty present on several topics essential to patient management and treatment of challenging conditions. “We learned about therapies for conditions that were,” according to Dr. Fowler, “largely untreatable just a few years ago, including hidradenitis and vitiligo.” These presentations included “Finally Some Options for Vitiligo” and “Hidradenitis Suppurativas: Do You Want to Be A Dermatologic Superhero?”—both presented by Iltefat Hamzavi, MD. You can access those presentations on-demand here. 

The two full Medical Dermatology sessions on Days 1 and 2 are extremely valuable to all dermatology specialists. Dr. Linda Stein Gold, who co-chairs the conference with Dr. Fowler and Drs. Michael Kaminer and Larry Eichenfield, explained, “What I appreciate about this meeting is that here I get the update on medical dermatology. I get the update on pediatric dermatology. I get the update on pigmented lesions and such. I also want the update on what's new in cosmetics so I can make sure to understand the cutting edge.”

“I am excited to be directing the Thursday program on Medical Dermatology,” Day 2 Session Chair Dr. Larry Eichenfield shared. “This will be an incredible set of talks, built around challenging and instructional patient cases. The program includes Dr. Jeffrey Callen discussing dermatomyositis and lupus, his “Top 5 Items” from the medical dermatology literature, and a set of “Best Cases of Las Vegas” chaired by Dr. Miriam Bettencourt. It also includes my discussion of life-threatening pediatric dermatoses (or are they?). The interactive Q&A section should be lively and educational as well!”

The interactive faculty panel that our Day 2 session ends with will undoubtedly touch on these and other hot topics such as acne, rosacea, and actinic keratosis. Also, don’t miss the Resident’s Program "Ask Me Anything" bonus panel that follows Thursday at 8pm EST. Dr. Fowler, a panelist along with Drs. Kenneth Gordon and Jacqueline Watchmaker, commented, “We look forward to sharing a lot of ideas with residents to benefit their future practice situations.” Don’t miss it!

Don’t forget that as a virtual attendee, you can network with colleagues beyond the educational sessions, visit booths in the Virtual Exhibit Hall right from your desk, experience peer-to-peer learning in the Virtual Poster Hall and access the virtual platform for on-demand access until January 2022. Register here!

“I am excited about the superb faculty and the outstanding content that has been put together for this virtual symposium,” stated Dr. Eichenfield. “The meeting will deliver clinically relevant information, getting us up to speed on the latest advances in dermatology, while emphasizing material to help us deliver state of the art dermatology care to our patients.” 
—by Colleen Hutchinson

Don’t miss! Check out our conference co-chairs discussing this conference (and sharing some pearls from their upcoming presentations) in this short video, Linked In Live Las Vegas Dermatology Seminar Preview - MedscapeLIVE! To view that brief roundtable online, click here!
 

 

November 2021

Daily – Session 1

by Colleen Hutchinson

At the dynamic virtual 22nd Annual Las Vegas Dermatology Seminar, attendees look forward to thought leaders sharing critical insights on topics such as new treatments in psoriasis and atopic dermatitis.  
As a virtual attendee this year, you can take advantage of robust opportunities to interact with colleagues beyond the educational sessions. Please take advantage of the virtual conference features that Medscape has provided, including visiting booths in the Virtual Exhibit Hall (without having to move from your chair!), participating in peer-to-peer learning in the Virtual Poster Hall, networking with other dermatology specialists and practitioners, and accessing the virtual platform for on-demand access until January 2022. 
Read on to see the most critical content from the first session of the conference.
Also, don’t miss the conference co-chairs discussing this conference (and sharing some pearls from their upcoming presentations) in this short video, Linked In Live Las Vegas Dermatology Seminar Preview - MedscapeLIVE! To view the brief roundtable online, click here!
Dr. Linda Stein Gold, who co-chairs the Las Vegas Dermatology Seminar, commented, “I am looking forward to the exciting things that we're going to see at this meeting—there is so much! The agenda is action packed. We traditionally look to this meeting as a very comprehensive overview of what's new in psoriasis, and we still will be delivering that, as we talk about psoriasis from all different aspects and bring attendees up to date. But as with psoriasis, we are approaching the topic of atopic dermatitis similarly—taking a holistic approach to those and some other conditions as well. I am able, as are all attendees, to really look to this meeting to bring me up to date on what's new in medical dermatology.” 
According to Dr. Joe Fowler, another LVD co-chair, one of the most valuable aspects of this meeting is the case reports. “We have case reports from local physicians, and one local dermatologist in Las Vegas is, to me, always a highlight. They may not have the same scientific background as other presenters, but that makes no difference—these are valuable cases and very instructive, and they're always presented very well. It’s another highlight of this meeting.”
Dr. Neal Bhatia presents today on “The Best Treatments for Actinic Keratoses.” Dr. Bhatia explained, “Some pearls from my first presentation on proper treatment of actinic keratosis (AK) and optimizing topical treatments are: 1) have patients fill prescriptions between Monday and Thursday, as then it is less likely to be switched than on Fridays or weekends, and 2) Have patients start treatments on Sundays so that reactions occur mid-week rather than on weekends. Also,” he continued, “don’t shortchange freezing times with cryo just like incubation with PD—Make the patients do the time especially for extremities…and remember to communicate that anticipated local skin reactions are not side effects—be a cheerleader for the outcomes.”
Some takeaways from Dr. Bhatia’s second presentation, “Molluscum and Warts: An Update,” are that some destructive and immune-based therapies approved for AKs have been studied off-label for warts; costs, tolerability, and compliance are all limiting factors; and summaries of combination studies with cryo for warts are incomplete unless studied against topical therapies alone.
Today’s opening session presentations included “Hidradenitis Suppurativas: Do You Want to Be a Dermatologic Superhero?” from Dr. Iltefat Hamzavi and “Pearls in the Management of Patients with Atypical Nevi and Melanoma” from Dr. Stephen Wang.
Additionally in this first session of the 22nd Annual Las Vegas Dermatology Seminar, Dr. Emmy Graber’s first presentation, “The Best Treatments for Actinic Keratoses,” revealed new and emerging agents in this dermatological therapeutic area. Dr. Graber also shares tips in her second presentation, “Rosacea: Managing Your Patients.”  
Don’t miss “Sweating It Out: Managing Hyperhidrosis in Your Patients,” from  Dr. David M. Pariser and look for new treatment options to be shared by Dr. Hamzavi in “Finally Some Options for Vitiligo.”
In addition to catching the presentations, case reports, virtual exhibits and poster hall, make sure to visit our live Q&A panels from this first session at 7:10pm and 8:50pm EST.
Join us to learn more about how to better care for your patients and learn about critical advances in diagnosis and treatment of skin diseases. You don't want to miss out!
by Colleen Hutchinson

 

 

October 2021

Looking Forward to LVD 2021!

Welcome back! Innovations in Dermatology is back in your inbox this month with a group panel opining on what’s hot at the upcoming virtual 22nd Annual Las Vegas Dermatology Seminar, which is November 10-14 next month. Register now for this innovative conference on November 10-14! 
Also, make sure to check out the Linked In Live Las Vegas Dermatology Seminar Preview - MedscapeLIVE! This is a short video I moderated with a few faculty who share some pearls from their upcoming presentations at the Las Vegas Dermatology Seminar. To view that brief roundtable online, click here!
In last month’s issue, we shared key insights from a group panel opining on what can be a touchy subject: Industry’s role as a partner in dermatology education and research. Currently, pharmaceutical and device manufacturers fund more than half of the medical research in the US, according to the NIH. Since the entire biomedical research community, government, academia, industry, and patients have a shared interest in the development of new technologies, treatments and targeted therapies, this is a hot topic no matter what angle you’re looking at it. If you missed it, you can find that interview here.
This month’s Derm Resource section will keep you updated with articles from Dermatology News JAMA, Cutis, and NEJM and a CME/CE Certified Supplement from the Hawaii Dermatology Seminar— Acne: Step Up the Use of Nonantibiotic Systemic Therapy.
We're pleased to announce the 22nd Annual Las Vegas Dermatology Seminar! Tune in to hear from the faculty as they discuss various treatment and therapeutic options and the latest updates in dermatology. Join us to learn more about how to better care for your patients and learn what you can expect from the upcoming MedscapeLIVE! virtual event. You don't want to miss out! 
Thank you to these thought leaders for their critical contribution to a discussion on what’s to come at the upcoming 22nd Annual Las Vegas Dermatology Seminar. Please contact me at [email protected] with comments or suggestions. Thanks for reading!

Colleen Hutchinson

 

Interview

Looking Forward to LVD 2021! An Interview with Faculty
 

Colleen: Dr. Bhatia, what are one or two pearls that attendees should come away with and be able to translate to practice from your upcoming presentations at the LVD Seminar 2021?
Dr. Neal Bhatia:
Some pearls from my first presentation on proper treatment of actinic keratoss and optimizing topical treatments are: 1) have patients fill prescriptions between Monday and Thursday, as then it is less likely to be switched than on Fridays or weekends. 2) Have patients start treatments on Sundays so that reactions occur mid-week rather than on weekends. 3) Do not shortchange freezing times with cryo just like incubation with PD—Make the patients do the time especially for extremities. 4) Anticipated local skin reactions are not side effects—Be a cheerleader for the outcomes!

Another set of pearls from my presentation on topical treatments for warts to reduce recurrence and optimize clearance are: 1) Same destructive and immune-based therapies approved for AKs have been studied off-label for warts. 2) Costs, tolerability, and compliance are all limiting factors. 3) Summaries of combination studies with cryo for warts are incomplete unless studied against topical therapies alone.

Colleen: Dr. Bonati, what is one of the most recent new treatment options that can be adopted to your practice that you find most valuable?
Dr. Lauren Bonati:
Cellulite has been estimated to effect between 85-98% of post-pubertal women. While many factors lead to the development of cellulite, thick fascial bands of connective tissue orient longitudinally and tether the soft tissue down from dermis to deep fascia. A new injectable that has shown promise utilizes Collagenase Clostridium Hystolyticum, a bacterial enzyme that dissolves fibrous septae and improves the appearance of cellulite. It is a series of in-office injections that is now being marketed and used in practice.

Colleen: Dr. Ibrahim, what is something on the horizon that isn’t quite practice-ready but will be of extreme value to add to the armamentarium of the practicing dermatologist?
Dr. Omer Ibrahim:
Exosomes may be the new frontier in anti-aging aesthetic dermatology. Exosomes are derived from donated mesenchymal cells and contain growth factors, cytokines, proteins and mRNA. In the lab, early studies have shown that exosomes may help with wound healing and tissue regeneration. Hopefully over the years, these studies will translate into clinical trials on exosome use on hair regeneration and skin rejuvenation either by injection or in conjunction with laser resurfacing.

Colleen: Dr. Stein Gold, on Day 3 of the LVD Seminar, we have the Atopic Dermatitis Forum. Your presentation is up first. Can you tell us a little about what's new in topical treatment that viewers will be learning about at the meeting?
Dr. Linda Stein Gold:
Absolutely. You know, we have to remember that topical therapy is still the mainstay of therapy, especially for atopic dermatitis, and most of our patients really have more mild to moderate or localized disease. And that means they can be handled by topical therapy.
So I'll go over some of the basics, like bathing. We all know that the so conceal method is really superior in terms of cleansing and hydrating the skin, and we will show some data about why bathing more often is actually better than less frequently.
We'll take a look at some of the possible prevention studies that have been done to see if we can change the natural history of atopic dermatitis. Unfortunately, at this point, I don't think we're there yet.
We've had the topical calcineurin inhibitors—we’ll see how they compare to the newer drugs like the phosphodiesterase inhibitors. And then we'll take some time and really look into our new treatment options, especially that the topical JAK inhibitors, we've had a very exciting update as we know that the first topical JAK inhibitor, a one and two inhibitor ruxolitinib, was actually FDA-approved just a few weeks ago. So we'll go over that data. We'll look at how and when to use that drug while also trying to dissect out that box warning and what that actually means for prescribers. Bottom line is, this is a really effective drug that's safe as long as we kind of stay in our lane with topical therapy and use it as indicated, up to 20% of body surface area.

Colleen: Dr. Kaminer, on Day 5 of the LVD Seminar, we have aesthetics. What's new regarding injecting techniques with neuromodulators that attendees will learn about? 
Dr. Michael Kaminer:
I think the world of aesthetics has evolved, certainly during the pandemic, we've had a lot to deal with, both in general dermatology, and specifically anesthetic medicine. What's interesting specifically about your question of neuromodulators is some of the evolution of neuromodulators that's starting to trend toward more natural results.
One may think, we've been producing natural results for years. That's the whole point. But the reality is we've all seen people both on TV and the media, friends, etc., who have been overdone and look overfrozen. And that's not an accident. Those things happen for a reason. But we're starting to understand better why people look overdone. And I think what clinicians want to know is, how do you make people look natural? We will talk about all of this. Predictably, we'll also talk about some of the new neuromodulators that might be coming. So while it's sort of an oldie but a goodie, there are a lot of interesting developments in neuromodulators. But I think we all can learn from this presentation and it will be of great value to attendees. 

 
Dermatology Resource Section: 

Innovations in Dermatology Virtual Spring Conference 2021: Available Online Here: 
https://na.eventscloud.com/website/20848/

Dermatology News Article: Artificial intelligence wish list
https://www.mdedge.com/dermatology/article/243068/business-medicine/artificial-intelligence-wish-list

Cutis Article: Phototherapy: Safe and Effective for Challenging Skin Conditions in Older Adults
https://www.mdedge.com/dermatology/article/243498/contact-dermatitis/phototherapy-safe-and-effective-challenging-skin

NEJM Article: To Scar or Not to Scar
https://www.nejm.org/doi/full/10.1056/NEJMcibr2107204

Acne: Step Up the Use of Nonantibiotic Systemic Therapy—
A CME/CE Certified Supplement from the Hawaii Dermatology Seminar
https://www.globalacademycme.com

JAMA Dermatology: What Matters the Most to Adult Women With Acne? —Editorial
https://jamanetwork.com/journals/jamadermatology/article-abstract/2782443

JAMA Dermatology Original Investigation: Patient Perspectives on the Lived Experience of Acne and Its Treatment Among Adult Women With Acne—A Qualitative Study
https://jamanetwork.com/journals/jamadermatology/article-abstract/2782440

 

July/August 2021

Hot Topics in Dermatology with KOLs: The Role of Industry

Welcome back! Innovations in Dermatology is back in your inbox this month with a group panel opining on what can be a touchy subject: Industry’s role as a partner in dermatology education and research. According to the NIH, pharmaceutical and device manufacturers fund more than half of the medical research in the US. The entire biomedical research community, government, academia, industry, and patients have a shared interest in the development of new technologies, treatments and targeted therapies. But the relationship 
In last month’s issue, we shared key insights from an interview with Lauren Meshkov Bonati, MD. Topics included the most current research on noninvasive injectable treatments for the transgender population, critical takeaways from her recent Dermatological Clinics article on care for the lesbian, gay, bisexual, and transgender community,” findings from her Lasers in Surgery and Medicine article, “Sound levels and safety in cosmetic laser surgery,” and what she considers the most useful new tools/devices in the dermatologist’s arsenal. If you missed it, you can find that interview here.
This month’s Derm Resource section will keep you updated with articles from Dermatology News JAMA, Cutis, and NEJM and a CME/CE Certified Supplement from the Hawaii Dermatology Seminar— Acne: Step Up the Use of Nonantibiotic Systemic Therapy.
Innovations in Dermatology: Virtual Spring Conference 2021 is a MedscapeLIVE! event from the producers of the Hawaii Dermatology Seminar and Caribbean Dermatology Symposium. With 8 live-streamed sessions over a 5-day period in March and daily oral presentations on selected abstracts and interactive case-based discussion based on attendee case submissions, this was an educational event not to miss. (If you did, however, each session is available for immediate on-demand access.)
Thank you to these thought leaders for their critical contribution to a discussion on industry and its role. Please contact me at [email protected] with comments or suggestions. Thanks for reading!

Colleen Hutchinson

 

Interview

Hot Topics in Dermatology: Industry’s Role as a Partner in Education and Research
 
Colleen: How would you characterize the evolution of industry’s role as a partner in dermatology education and research and what it is today?

Dr. Michael Kaminer: Industry has become an essential and valued partner in dermatology. Their support for educational programs specific to their technology, as well as regional and national societies and meetings, is the lifeblood of our specialty. It helps to advance the knowledge base and skill set of the entire field.
The boom in clinical research has been phenomenal over the past two decades. Both in cosmetic and general dermatology, the evolution of new drugs, devices, and technology has been remarkable. Coupled with the evidence-based focus of dermatology, industry has embarked on research that has significantly supported and enhanced our specialty.

Dr. Lauren Bonati: Industry has played and continues to play a large role in dermatology education and research. There is a symbiotic relationship between medicine and industry overall, whereby gaps in care are identified, new innovations are tested for safety and efficacy, and everyone is ultimately pushed forward. Over time this relationship has matured and become more interwoven with the realities of how a technology or new medical treatment fits into real life clinic. It has also become more inclusive of minority patient populations.

Dr. Katie Beleznay: I value the role industry plays in supporting research and education that can advance our field. I think it is important for dermatologists and industry to collaborate to ensure that we have good evidence-based treatments. Whether in terms of skin conditions such as acne or psoriasis, or in the realm of cosmetic dermatology, we would not be able to offer our patients the treatment options we have available today without the work of industry partners.

Dr. Neal Bhatia: I think dermatologists should collaborate with industry for medical education as well as research if it interests them. There are methods of doing this while avoiding the pitfalls often associated with the industry-thought leader/clinician relationship. These include developing a niche of his/her interest, publishing work because he/she is passionate, and writing his/her own presentations that are disease- and therapy-based—not related to products or brands or containing corporate-sponsored slides. This will demonstrate expertise in a chosen field and opportunities will come to you rather than the other way around.

Dr. Jeremy Green: My partners and I conduct clinical trials in both aesthetic and medical dermatology. Our intellectual curiosity has also lead us to self-fund small projects. While very rewarding, the costs involved (IRB, staffing, product, our time, etc.) remind me that if it was solely up to busy practicing dermatologists to innovate, our field would be running in quicksand. With its considerable resources, industry is an absolutely essential partner for advancement in dermatology. It's a symbiotic relationship that for the most part enhances our ability to care for patients.

Dr. Linda Stein Gold: I see industry as a true partner with the dermatology community.  We have seen an explosion of new technology with targeted treatments, and much of this research has come from industry. With our increased understanding of the pathogenesis of diseases, such as atopic dermatitis and psoriasis, industry has taken a lead in educating the dermatology community on the new developments.

Dr. Shilpi Khetarpal: The role of industry in dermatology education has evolved over time. They now have opportunities for resident education, research grants, and sponsorship of meetings. All of these allow current and future dermatologists to make advances in our field and promote education. Industry has also been helpful in providing patient educational materials.

 
Dermatology Resource Section: 

Innovations in Dermatology Virtual Spring Conference 2021: Available Online Here:
https://na.eventscloud.com/website/20848/

Dermatology News Article: Artificial intelligence wish list
https://www.mdedge.com/dermatology/article/243068/business-medicine/artificial-intelligence-wish-list

Cutis Article: Phototherapy: Safe and Effective for Challenging Skin Conditions in Older Adults
https://www.mdedge.com

NEJM Article: To Scar or Not to Scar
https://www.nejm.org/doi/full/10.1056/NEJMcibr2107204

Acne: Step Up the Use of Nonantibiotic Systemic Therapy—
A CME/CE Certified Supplement from the Hawaii Dermatology Seminar
https://www.globalacademycme.com

JAMA Dermatology: What Matters the Most to Adult Women With Acne? —Editorial
https://jamanetwork.com/journals/jamadermatology/article-abstract/2782443

JAMA Dermatology Original Investigation: Patient Perspectives on the Lived Experience of Acne and Its Treatment Among Adult Women With Acne—A Qualitative Study
https://jamanetwork.com/journals/jamadermatology/article-abstract/2782440

 

June 2021

Hot Topics in Dermatology with Dr. Lauren Bonati: Issues in our transgender population, safety with lasers, and more!

Innovations in Dermatology is back in your inbox this month with an interview with Lauren Meshkov Bonati, MD. Dr. Bonati is a board-certified dermatologist and Mohs surgeon practicing in Vail, Colorado. She completed her dermatology training at Mount Sinai Icahn School of Medicine in New York City and completed advanced fellowship training in cosmetics, lasers, and Mohs surgery at SkinCare Physicians in Boston. Dr. Bonati actively participates in the clinical research of new energy devices and is active in publishing and lecturing. Dr. Bonati and I dove right into several hot topics, including the most current research regarding on noninvasive injectable treatments for the transgender population, critical takeaways from her recent Dermatological Clinics article, “A New Era of Care for the Lesbian, Gay, Bisexual, and Transgender Community,” findings from her Lasers in Surgery and Medicine article titled “Sound levels and safety in cosmetic laser surgery,” and what she considers to be the most useful and innovative new tools and/or devices in the dermatologist’s arsenal.

In last month’s issue we shared key insights from Neal Bhatia, MD. Topics included advances in topical and systemic therapies that are now safer and easier to incorporate, lesser known options for treating skin cancer treatment options, critical findings of the recent randomized clinical trial of tapinarof cream for treatment of plaque psoriasis, his recent article on handwashing, and prescribing oral antibiotics for acne and the use of newer strategies and compounds to reduce adverse-event profiles and antibiotic resistance. If you missed it, you can find that interview here.

Innovations in Dermatology: Virtual Spring Conference 2021 is a MedscapeLIVE! event from the producers of the Hawaii Dermatology Seminar and Caribbean Dermatology Symposium. With 8 live-streamed sessions over a 5-day period in March and daily oral presentations on selected abstracts and interactive case-based discussion based on attendee case submissions, this was an educational event not to miss. (If you did, however, each session is available for immediate on-demand access.)

This month’s Derm Resource section will keep you updated with a Dermatology News article on Cellular senescence, skin aging, and cosmeceuticals, a JAMA Dermatology article titled “Incidence of Cutaneous Reactions After Messenger RNA COVID-19 Vaccines,” an article in Cutis titled “Reexamining the Role of Diet in Dermatology,” a NEJM article titled “Recent Advances in the Treatment of Melanoma,” and a CME/CE Certified Supplement from the Hawaii Dermatology Seminar— Acne: Treatments Beyond Localized Skin Surgery for BCC, SCC, and Localized Melanoma.

Thank you to Dr. Bonati for his critical contribution on what’s new for several dermatological conditions. 

Don’t forget to check out the Innovations in Dermatology: Virtual Spring Conference 2021 here, and please contact me at [email protected] with comments or suggestions. Thanks for reading!
Colleen Hutchinson

 

Interview

Hot Topics in Dermatology with Dr. Lauren Bonati: Issues in our transgender population, safety with lasers, and more!
Lauren Bonati, MD, is a board-certified dermatologist and Mohs surgeon practicing in Vail, Colorado. She completed her dermatology training at Mount Sinai Icahn School of Medicine in New York City and completed advanced fellowship training in cosmetics, lasers, and Mohs surgery at SkinCare Physicians in Boston. Dr. Bonati actively participates in the clinical research of new energy devices and is active in publishing and lecturing.

Colleen: Please tell us about the most current research regarding whether or not noninvasive injectable treatments are worthwhile for the transgender population.
Dr. Bonati:
While transgender medicine is growing as a whole, dermatologic transgender care remains understudied.  As the dermatologic community strives to learn and publish more on transgender medical care, there is a need for better instruction on the delivery of aesthetic interventions. Further data on the effectiveness of non-invasive cosmetic treatments for changing gender perception will enhance our ability to address gender dysphoria, a debilitating condition that often leads to persistent depression and anxiety throughout adulthood. This was the purpose of my own research on quality of life in transgender persons after neurotoxin and fillers.  

Colleen: In a special issue of Dermatological Clinics, you coauthored the article, “A New Era of Care for the Lesbian, Gay, Bisexual, and Transgender Community.” 
Can you give us the main takeaways from this that are critical for dermatologists to know and embrace for better patient care?

Dr. Bonati: LGBTQ+ awareness in the United States is growing, yet there remain significant health disparities as a result of stigma, poor health care access, and a general lack of policies and protections for this population. It is our duty as leaders in dermatology and medicine in general to set a precedent of inclusion and non-prejudice for all. In our Dermatologic Clinics textbook, entitled “Lesbian, Gay, Bisexual, and Transgender Dermatology,” we address some of the most common dermatologic concerns of LGBTQ+ patients. A few examples are acne in the transgender patient, gender specific dermatoses, the benefits of noninvasive cosmetic procedures, and how to make your practice LGBTQ+ friendly. We need more scholarly articles, talks, and curriculum of this nature so that clinicians may participate more confidently in the care of this at-risk population.

Colleen: Can you give us some insights from your latest article in The Journal of the American Academy of Dermatology (JAAD), “The effects of neurotoxin and soft tissue fillers on gender perception in transgender individuals: A pilot prospective survey-based study”?
Dr. Bonati: While surgery has long been the mainstay of treatment for gender dysphoria in transgender individuals, our new research shows that injectables may play a role for those who are not yet ready or able to pursue more invasive solutions. After treating 9 transgender individuals with neurotoxin and soft tissue fillers, pre and post treatment surveys showed that even small changes in physical appearance improved quality of life and self-perceived gender perception in all subjects. This is the first study of its kind to show quality of life benefits associated with injectable treatments in this patient population.
Although results were encouraging, it was a small study with limited follow-up. In real life clinic, patients should be counseled that injectables are expensive, not covered by insurance, and may not yield the dramatic results of gender affirmation surgery and hormonal therapy. Noninvasive treatments should be viewed as an adjunct, not a monotherapy. It is our hope that this study will spur others on to both do more research and continue treating transgender patients.
 
Colleen: Sound levels in cosmetic laser surgery continue to be a topic of discussion. What were your findings in the Lasers in Surgery and Medicine article, “Sound levels and safety in cosmetic laser surgery”?
Dr. Bonati: Laser safety has long been synonymous with eye safety. Wearing appropriate eye protection is pretty much a given at this point, but there is little to no data on auditory safety. This topic piqued our interest after using a very loud picosecond laser to remove tattoos.  After investigating every laser in our practice (and a few others), we luckily found that the majority of lasers are nowhere near the decibel level required for hearing loss. Even the noisiest of lasers were safe given their short duration of use. The cumulative number of hours needed to trigger hearing loss is way beyond even the busiest laser practice. It’s nice to have evidence-based safety data on lasers and hearing in the same way we have data on eye protection.
 
Colleen: What would you consider to be the most useful and innovative new tools and/or devices in the dermatologist’s arsenal?
Dr. Bonati: That is a tough question given the broad array of new tools and devices continually being brought to market! However, the fact that we do have such a wide variety of devices that can be used in combination is probably my favorite thing to do. Using several modalities that you know inside and out is a superb way to enhance results while maintaining safety and efficacy. New devices are exciting but often promise more than they deliver. As such, I have found that combining old standbys that are tried and true is a great way to enhance results without taking on excess risk. For instance, one of my favorite and most commonly done multi-modality treatments is for scar revision and includes the Pulsed Dye Laser, CO2 resurfacing, ILK/5FU injections, and dermabrasion.

 
Dermatology Resource Section: 

Innovations in Dermatology Virtual Spring Conference 2021: Available Online Here: https://na.eventscloud.com/website/20848/

Dermatology News Article: A Cosmeceutical critique: Cellular senescence, skin aging, and cosmeceuticals
https://www.mdedge.com

Cutis Article: Reexamining the Role of Diet in Dermatology
https://www.mdedge.com/dermatology/article/241252/rosacea/reexamining-role-diet-dermatology

NEJM Article: Recent Advances in the Treatment of Melanoma
https://www.nejm.org/doi/full/10.1056/NEJMra2034861

Acne: Treatments Beyond Localized Skin Surgery for BCC, SCC, and Localized Melanoma —
A CME/CE Certified Supplement from the Hawaii Dermatology Seminar
https://www.globalacademycme.com

JAMA Dermatology: History, Diagnosis, Pathogenesis, and Nomenclature in Sublamina Dense-Type Linear IgA Disease —Editorial
https://jamanetwork.com/journals/jamadermatology/article-abstract/2781366

JAMA Dermatology: Incidence of Cutaneous Reactions After Messenger RNA COVID-19 Vaccines—Research Letter
https://jamanetwork.com/journals/jamadermatology/newonline
 

 

May 2021

Hot Topics in Dermatology: Hair Loss, Collagen, & RFMN: What’s the Latest and Greatest?

Innovations in Dermatology is back in your inbox this month with a candid interview with Neal Bhatia, MD, FAAD, who is Vice President-Elect for the American Academy of Dermatology and practices in Los Angeles, California. Dr. Bhatia and I dove right into several hot topics, including advances in topical and systemic therapies that are now safer and easier to incorporate—and that can avoid surgical risks and/or high recurrence potential, options for treating skin cancer treatment options that are lesser known or less relied upon but should be more utilized, critical findings of the recent randomized clinical trial of tapinarof cream for the treatment of plaque psoriasis, his recent article on handwashing is interestingly titled (Revisiting Handwashing - As It Is Absolutely Essential; Dermatol 2020 Nov 1;19(11):1127-1129), and considerations when prescribing oral antibiotics for acne and the use of newer strategies and compounds to reduce adverse-event profiles and antibiotic resistance, and to optimize outcomes.

In last month’s issue we shared key insights from Shilpi Khetarpal, MD, an associate professor in dermatology at the Cleveland Clinic Foundation who specializes in cosmetic and procedural dermatology. Topics included current research on the role of collagen supplementation, the efficacy and safety of RFMN and how it compares with other energy-based devices, and the newest innovations and research findings in hair loss. If you missed it, you can find that interview here.

Innovations in Dermatology: Virtual Spring Conference 2021 is a MedscapeLIVE! event from the producers of the Hawaii Dermatology Seminar and Caribbean Dermatology Symposium. With 8 live-streamed sessions over a 5-day period in March and daily oral presentations on selected abstracts and interactive case-based discussion based on attendee case submissions, this was an educational event not to miss. (If you did, however, each session is available for immediate on-demand access.)
This month’s Derm Resource section will keep you updated with a Dermatology News article on botulinum toxin and depression, a JAMA Dermatology Original Investigation: Internet-Delivered Cognitive Behavior Therapy for Atopic Dermatitis, an article in Cutis titled “Tanning Attitudes and Behaviors in Adolescents and Young Adults,” a NEJM article titled “Trial of Upadacitinib and Adalimumab for Psoriatic Arthritis,” and a CME/CE Certified Supplement from the Hawaii Dermatology Seminar— Acne: Step Up the Use of Nonantibiotic Systemic Therapy.
Thank you to Dr. Bhatia for his critical contribution on what’s new for several dermatological conditions. 

Don’t forget to check out the Innovations in Dermatology: Virtual Spring Conference 2021 here, and please contact me at [email protected] with comments or suggestions. Thanks for reading!
Colleen Hutchinson

 

Interview

Hot Topics in Dermatology: Skin cancer treatment options, tapinarof cream for plaque psoriasis, the role of oral antibiotics for acne, handwashing—is it essential?, and oral antibiotics for acne.
Neal Bhatia, MD, FAAD, is Vice President-elect, American Academy of Dermatology, Secretary/Treasurer, Noah Worcester Dermatological Society, President, Pacific Dermatologic Association, and practices in Los Angeles. He is also Director of Clinical Dermatology, Therapeutics Clinical Research and Associate Clinical Professor, Harbor-UCLA Medical Center.

Colleen: You recently co-chaired the Innovations in Dermatology: Virtual Spring Conference 2021 session, “The Cutting Edge on Cutaneous Malignancies.” You commented that opportunities to maximize combinations of medical and surgical interventions, similar to oncologists, will lead to better clearance and safer alternatives for patients. You also stated that “Many patients have risks such as anticoagulants and other comorbidities, or having malignant tumors near the eyes, ears, and nose, as well as on the legs, where surgery might involve potential risks or high recurrence potential.”
What are some of the advances in topical and systemic therapies that are now safer and easier to incorporate, and that can avoid those surgical risks and/or high recurrence potential?

Dr. Bhatia: Dermatologists need to become more familiar as well as more comfortable with the potential impact of hedgehog inhibitors and checkpoint inhibitors as not only adjuncts to surgery for reducing recurrence, but also for improving surgical outcomes for larger tumors or those in areas of difficulty, such as pre-tibial areas, post-auricular, facial subunits, or other areas on the body. These therapies may require dose titration, lab monitoring, and extensive education for patients and families on potential adverse events. However, given new study data on the efficacy and safety of sonidegib and the new indication for cemiplimab for basal cell carcinoma (BCC), as well as new therapies in development such as patidegib gel, dermatologists need to be active participants and managers of these therapies or risk being marginalized as a specialty that cannot treat serious diseases.
 
Colleen: You had stated, “Unlike the stereotype of the pimple popper that Jerry Seinfeld created, dermatologists have a lot of options for treating skin cancer in addition to surgery.” What are some of the options that may be lesser known or less relied upon, but should be more utilized?
Dr. Bhatia: Dermatologists cannot allow the image portrayed by that Seinfeld episode or any other stereotype that we are just pimple poppers or glorified aestheticians. We have to be aggressive with our scope and make sure that oncologists and referring primary care physicians recognize our roles as the experts in treating skin cancer. Many of the drugs that were approved for treating actinic keratoses have been used for treating BCC, squamous cell carcinoma (SCC) in situ, and other tumors. Imiquimod is still FDA-approved for BCC, but it has not been as widely used out of lack of comfort with managing local skin reactions, and ingenol mebutate’s withdrawal from the US market has left us without a short duration treatment. It will be interesting to see if tirbanibulin is used off-label as a topical option for skin cancer despite the lack of data, and I would like to see more dermatologists becoming advocates for chemoprevention with either retinoids, nicotinamide, or photodynamic therapy, which are essential ingredients for managing the high-risk patients.

Colleen: Can you share with us the critical findings of the recent randomized clinical trial of tapinarof cream for the treatment of plaque psoriasis?
Dr. Bhatia: Our research site was one of many involved in the pivotal trial for tapinarof cream for psoriasis, but the sky is the limit for this drug as for many others that are coming, including roflumilast and ruxolitinib. The new agents should not just be considered alternatives to topical steroids, but as having impact on the disease processes themselves to reduce recurrence potential and to change patient outcomes. The data reported from the tapinarof trial was very encouraging, especially for a cream vehicle in psoriasis, so hopefully as approval dates arise we will have another option for not only psoriasis but other dermatoses as well. 
As with every new therapy, a thorough understanding of the mechanisms of action will provide opportunity for application in other arenas as well as open doors for treatment options for frustrated patients.
 
Colleen: Your recent paper on handwashing is interestingly titled (Revisiting Handwashing - As It Is Absolutely Essential; Dermatol 2020 Nov 1;19(11):1127-1129). Can you tell us about it?
Dr. Bhatia: Sadly, the pandemic exposed a lot of our bad habits, but I still have PTSD from watching how many people leave the bathroom without washing their hands…also a reference to the Seinfeld episode with Poppy but that is another story. All kidding aside, the article was meant to increase the awareness of why handwashing is so critical in not only reducing spread of contaminants, but also reducing the reliance on hand sanitizers, which are horrible for the skin given the amount of alcohol and preservatives. Dermatologists have seen so many new cases of hand eczema during the pandemic from overuse of sanitizers, which could have been avoided if patients took the time to wash their hands not only more frequently, but also with better technique and cleansers. So the authors all collaborated to create this article for the benefit of educating readers on the importance of not only the regular incorporation of hand washing but how to do it correctly…and yes, especially after using the washroom.
 
Colleen: The abstract to your recent review on oral antibiotics for acne reads, “When prescribing oral antibiotics, dermatologists need to consider dosage, duration, and frequency, and to avoid their use as monotherapy. These considerations are important, along with the use of newer strategies and compounds, to reduce adverse-event profiles, antibiotic resistance, and to optimize outcomes.” Can you elaborate?
Dr. Bhatia: The new guidelines for managing acne as published in the JAAD several years ago emphasized the need to avoid using antibiotics as monotherapy and to optimize topical therapies including benzoyl peroxide, retinoids, and other agents to maintain the gains for patients without compromising safety or inducing more potential for antibiotic resistance. There are now narrow spectrum antibiotics that are specifically meant for treating acne and newer formulations of both doxycycline and minocycline that are going to bring more options for patients. Shorter courses with holidays as well as dose titration strategies are all pivotal for success with using antibiotics, which should not be abandoned by any means but should be used wisely. My friend and colleague Dr. Jim Del Rosso equates antibiotics to knives: “They are excellent tools when used properly.”

 

Dermatology Resource Section: 

Innovations in Dermatology Virtual Spring Conference 2021: Available Online Here:
https://na.eventscloud.com/website/20848/

Dermatology News Article: Botulinum toxin and depression
https://www.mdedge.com/dermatology/article/240329/aesthetic-dermatology/botulinum-toxin-and-depression

Cutis Article: Tanning Attitudes and Behaviors in Adolescents and Young Adults
https://www.mdedge.com

NEJM Article: Trial of Upadacitinib and Adalimumab for Psoriatic Arthritis
https://www.nejm.org/doi/full/10.1056/NEJMoa2022516

Acne: Step Up the Use of Nonantibiotic Systemic Therapy—
A CME/CE Certified Supplement from the Hawaii Dermatology Seminar

https://www.globalacademycme.com

JAMA Dermatology: Internet-Delivered Cognitive Behavior Therapy for Atopic Dermatitis —Original Investigation
https://jamanetwork.com/journals/jamadermatology/article-abstract/2779785

 

April 2021

Hot Topics in Dermatology: Hair Loss, Collagen, & RFMN: What’s the Latest and Greatest?

Innovations in Dermatology is back in your inbox this month with a candid interview with Shilpi Khetarpal, MD, who is an associate professor in dermatology at the Cleveland Clinic Foundation and specializes in cosmetic and procedural dermatology. Dr. Khetarpal and I dove right into several hot topics, including the most current research regarding the role of collagen supplementation, the efficacy and safety of radiofrequency microneedling (RFMN) and how it compares with other energy-based devices, and the newest innovations and/or research findings in hair loss.
In last month’s issue we shared key insights from Dr. Omer Ibrahim, dermatologist and cosmetic and laser surgeon and co-director of research at Chicago Cosmetic Surgery and Dermatology. Dr. Ibrahim and I discussed the use of platelet-rich plasma (PRP) and stem cells for hair loss, photodamage and scarring, and the benefits and drawbacks of use of social media. If you missed it, you can find that interview here.

Innovations in Dermatology: Virtual Spring Conference 2021 is a MedscapeLIVE! event from the producers of the Hawaii Dermatology Seminar and Caribbean Dermatology Symposium. With 8 live-streamed sessions over a 5-day period in March and daily oral presentations on selected abstracts and interactive case-based discussion based on attendee case submissions, this was an educational event not to miss. (If you did, however, each session will also be available for immediate on-demand access following the conference.)

In this e-news, don’t miss the Suggested Reading from Dr. Khetarpal. Also, this month’s Derm Resource section will keep you updated with a Dermatology News article on price transparency, updated AADA guidelines on actinic keratosis (AK), an article in Cutis titled “Phytophotodermatitis Is an Occupational and Recreational Dermatosis in the Limelight,” an original investigation in JAMA Dermatology titled “Long-term Outcomes and Prognosis in New-Onset Psoriasis,” and a CME/CE Certified Supplement from the Hawaii Dermatology Seminar—Cardiovascular Disease and Psoriasis.

Thank you to Dr. Khetarpal for her critical contribution on what’s new for several dermatological conditions. 

Don’t forget to check out the Innovations in Dermatology: Virtual Spring Conference 2021 here, and please contact me at [email protected] with comments or suggestions. Thanks for reading!
Colleen Hutchinson

 

Interview

Hot Topics in Dermatology: Hair Loss, Collagen, & RFMN: What’s the Latest and Greatest?
Shilpi Khetarpal, MD is an ASDS fellowship-trained, board-certified dermatologist who is an associate professor in dermatology at the Cleveland Clinic Foundation and specializes in cosmetic and procedural dermatology.

Colleen: Please tell us about the most current research and understanding regarding the role of collagen supplementation in skin rejuvenation.
Dr: Khetarpal:
There is limited data supporting the use of oral collagen supplementation for skin health and rejuvenation. Once an oral supplement is ingested, it is digested by the GI tract, so very little is absorbed. Additionally, supplements can have side effects like GI upset and food allergies because the supplement industry is not well regulated and has a history of inaccurate labeling, contamination, and other safety concerns.

Rather than taking oral collagen, I recommend protecting the collagen we have by using daily SPF and topical antioxidants. We lose collagen from environmental factors like sun, cigarette smoke, and pollution causing sun damage like wrinkling, dryness, and discoloration of the skin. It is better to protect skin from sun (SPF) and pollution (antioxidants), stay hydrated, and avoid cigarettes to care for the collagen you do have, rather than trying to replenish it with supplements.

Colleen: In a special issue of Dermatologic Surgery, you coauthored a critical review of radiofrequency microneedling (RFMN). Can you give us the main takeaways on your findings regarding the efficacy and safety of RFMN, and how it compares with other energy-based devices in a clinician's armamentarium?
Dr: Khetarpal: RFMN is a safe, effective treatment in patients of all skin types for various indications including acne, acne scarring, hyperhidrosis, cellulite, melasma, rosacea, skin rejuvenation and striae. There is an increasing amount of evidence in the literature supporting its use with the effects being slow and progressive. It can be used independently or in combination with other treatments to improve efficacy.
Compared to other therapies, RFMN is able to go deeper than lasers and, given that it only heats the dermis, it is safe in all skin types. There are numerous devices on the market that vary in terms of needle depth, insulation, number, and pulse duration. Not all devices are equal, so it is important to counsel patients accordingly. 

Colleen: Can you give us some insights from your latest article in Dermatology Online Journal, Patient Safety in Dermatology: A Ten-year Update?
Dr: Khetarpal:
This study looked at patient safety issues surrounding dermatology, including medication errors, diagnostic errors including telemedicine, office-based surgery, wrong-site procedures, COVID-19 and other infections, falls, laser safety, scope of practice and electronic health records. Despite the increasing number of dermatologic patient safety studies, our study suggests the need for more reports to reduce the number of preventable errors in order to provide optimal care.

Colleen: Can you share with us what you feel are the most useful and applicable innovations and/or research findings in hair loss treatment? 
Dr: Khetarpal:
Platelet rich plasma (PRP) is one of the newest and most popular treatments for hair loss in my practice due to its autologous nature and regenerative properties. PRP is an autologous concentration of platelets in plasma with numerous growth factors that contribute to hair regeneration. The growth factors contained within platelets act on stem cells in the hair follicles and stimulate development of new follicles along with growth of new blood vessels. It is a well-tolerated, in-office treatment that is used as adjunctive therapy in additional to medical therapies for androgenetic alopecia (AGA) and several other types of hair loss. 

Stem cells are a hot topic but are currently not FDA approved and require additional studies regarding efficacy and safety before becoming mainstream. But they do have a lot of potential as a hair loss therapy. 

Nutraceuticals are also very popular. These are supplements that are not prescription but are recommended by physicians and sold through their offices and can be used along with medical therapies and PRP. Newer therapies improve patient compliance by including a hair supplement, multivitamin and probiotic all in one.
 
Colleen: What would you consider to be the most useful and innovative new tools and/or devices in your dermatologist’s arsenal?
Dr: Khetarpal:
As a medical and cosmetic dermatologist, there are several things that I use on a daily basis. A dermatoscope is essential, allowing one to see high power magnification of specific skin lesions, both pigmented and non-pigmented. Electrocautery is a cost-effective, simple device that can be used to treat a variety of medical and cosmetic conditions like hemostasis during surgery, but also sebaceous hyperplasia, dermatosis papulosa nigra, syringomas, and other benign lesions in cosmetically sensitive areas. Injectables such as neurotoxins and hyaluronic fillers are safe and popular treatments. The new injectable for cellulite dimples on the buttocks also shows promise. Laser therapy is progressing at a rapid pace but lasers like the pulsed dye laser (PDL) and nano and picosecond lasers are workhorse devices. For skin texture, my favorite treatments are non-ablative fractional resurfacing and RFMN. Non-invasive skin tightening is also popular with monopolar radiofrequency being a treatment that many of my patients are very happy with. PRP for hair and skin rejuvenation along with microneedling are also great options for those wanting a more ‘natural’ treatment relying on the body’s own growth factors and wound healing response.

 
Suggested Reading

Article: COVID-19/SARS-CoV-2 virus spike protein-related delayed inflammatory reaction to hyaluronic acid dermal fillers: a challenging clinical conundrum in diagnosis and treatment. Munavalli GG, Guthridge R, Knutsen-Larson S, et al. Arch Dermatol Res. 2021 Feb 9;1-15. 
https://pubmed.ncbi.nlm.nih.gov/33559733/
Dr: Khetarpal: There is an increasing concern of filler reactions with COVID 19 vaccine from patients and other non-core aesthetic physicians. This article summarizes the diagnosis and treatment for these patients and is helpful in discussing this topic with patients and other physicians.

 

Dermatology Resource Section

Innovations in Dermatology Virtual Spring Conference 2021: Available Online Here: https://na.eventscloud.com/website/20848/

Dermatology News Article: Price transparency comes to medicine
https://www.mdedge.com/dermatology/article/237405/business-medicine/price-transparency-comes-medicine

Cutis Article: Botanical Briefs: Phytophotodermatitis Is an Occupational and Recreational Dermatosis in the Limelight
https://www.mdedge.com/dermatology/article/238481/contact-dermatitis/botanical-briefs-phytophotodermatitis-occupational-and

NEJM Article: Bimekizumab versus Secukinumab in Plaque Psoriasis
https://www.nejm.org/doi/full/10.1056/NEJMoa2102383

NEJM Article: Bimekizumab versus Adalimumab in Plaque Psoriasis
https://www.nejm.org/doi/full/10.1056/NEJMoa2102388

Topical Therapies for Psoriasis: Cardiovascular Disease and Psoriasis—
A CME/CE Certified Supplement from the Hawaii Dermatology Seminar
https://www.globalacademycme.com

JAMA Dermatology Editorial: Long-term Outcomes and Prognosis in New-Onset Psoriasis—Original Investigation
https://jamanetwork.com/journals/jamadermatology/article-abstract/2778388
 
American Academy of Dermatology Association (AADA) new guideline on actinic keratosis, including evidence-based recommendations for treatment:
https://www.aad.org/member/clinical-quality/guidelines/actinic-keratosis

 

Innovations in Dermatology Daily – Session 3

The seventh dynamic virtual session of Innovations in Dermatology: Virtual Spring Conference 2021, “Body of Evidence: Updates on Body Contouring” was co-chaired by Michael S. Kaminer, MD, and Sabrina G. Fabi, MD. Faculty presented on several critical topics and updates in body contouring, and the session was rounded out by an Ask the Experts panel that focused on OTC, skin and aesthetic dermatology. 
Regarding this last panel of the session, Dr. Kaminer commented, “In the session-closing Ask the Experts panel, Dr. Zoe Draelos and I have some quality case-based discussions on timely hot topics, including hyaluronic acid filler reactions in patients who receive the Covid vaccine. We also discuss other filler complications including vision loss. The cases presented by the audience provide for critical lively discourse and direction on various aspects of OTC, skin, and aesthetic dermatology treatments, and also provide pearls for patient selection and treatment optimization.”
Read on to learn about the most critical presentations from this session of the conference.
Colleen Hutchinson 

In her presentation, “Nonsurgical Skin Lifting: Boosting Collagen and Elastin,” Dr. Elizabeth Tanzi explored nonsurgical skin lifting, boosting collagen and elastin. Her presentation shared results from three devices, including radiofrequency micro-needling treatments for tightening, high intensity focused ultrasound, and a fractionated laser device to improve tone, texture and tightening. Dr. Tanzi stressed, “Realistic expectations are absolutely critical when talking about success. You have to talk to your patients, because even if they are good candidates, they can have mixed results.” She added, “Most patients need multiple treatments as well as maintenance treatments to obtain the best improvement because the aging process will continue to progress.” Going forward, Dr. Tanzi expects to see more combination treatments that use a device with potentially hyper-dilute injectables, calcium hydroxyapatite, or a very dilute polylactic acid to yield even more improvement than the devices alone can deliver. In closing, Dr. Tanzi shared that even if you have a perfect patient who is very appropriate for treatment, that patient can get an underwhelming response. She noted, “Advanced technology clearly yields more reliable results, but continued research is needed.”

Next, Dr. Michael Kaminer presented, “A Targeted Approach to Addressing Cellulite.”  Dr. Kaminer said that treatment options for cellulite are evolving, with a strong focus on fiber septae. He shared that for a long time nothing really worked to improve cellulite. However, during his update on what treatments are available, Dr. Kaminer reported, “Nearly all of the efficacy that comes in the treatment of cellulite comes when fiber septae are first targeted.” He shared three types of treatments that all include a breaking down of the fiber septae, including mechanical, acoustic, and chemical subcision. 

Dr. Kaminer advised attendees, “All cellulite is not equal, so try and match new technology to the patient’s cellulite and see if there are ways to either treat the fiber septae to make them better or perhaps use a filler as an adjunct.” He said that all of these things together may finally help treat patients with cellulite in a predictable and durable way.

Also in today’s session is a presentation by Dr. Sabrina Fabi on “Toning and Tightening: Appropriate Patient Selection to Optimize Effectiveness.” 

Please make sure to visit our live Q&A panel here and check out our “Ask the Experts” interactive session with Dr. Zoe Draelos and Dr. Michael Kaminer, featuring case-based discussions submitted by conference attendees with a focus on OTC (over the counter), skin, and aesthetic dermatology.
Jody Small

 

Innovations in Dermatology Daily – Session 2

At the third dynamic virtual session of Innovations in Dermatology: Virtual Spring Conference 2021, “The Cutting Edge on Cutaneous Malignancies,” Co-Chairs Ashfaq A. Marghoob, MD, and Neal Bhatia, MD, oversaw faculty present on several topics essential to patient management and treatment of cutaneous malignancies. Read on to learn about the most critical presentations from this session of the conference.
"Unlike the stereotype of the pimple popper that Jerry Seinfeld created, dermatologists have a lot of options for treating skin cancer in addition to surgery,” stated Session Co-Chair Neal Bhatia. “Many of the advances in topical and systemic therapies—some of which evolve from treating actinic keratoses and some from other visceral tumors—are now safer and easier to incorporate. Too many patients have risks such as anticoagulants and other comorbidities, or having malignant tumors near the eyes, ears, and nose, as well as on the legs, where surgery might involve potential risks or high recurrence potential.” Looking to the future, Dr. Bhatia concluded, “Our opportunities to maximize combinations of medical and surgical interventions, similar to oncologists, will lead to better clearance and safer alternatives for patients."
Colleen Hutchinson 

In his presentation, “Basal Cell Carcinoma: How to Effectively Manage Your Patients,” Dr. Vishal Patel explored current topics in basal cell carcinoma and how to effectively manage your patients. He explained that while basal cell carcinoma is the most common malignancy in the United States, it is unknown exactly how many cases are seen each year since there is no centralized database. Noting that effectively managing treatment for basal cell carcinoma “requires a little bit more thought than we sometimes initially put into the basal cell,” Dr. Patel suggests that in order to treat tumors effectively, it is important to begin by stratifying them into low risk and high risk. Dr. Patel explained that there is not a staging system for basal cell carcinoma. “We utilize the staging system for squamous cell carcinoma for basal cells, which is woefully inadequate.” He revealed that a paper will be released soon that will propose a new staging system for basal cell carcinoma but said, “This just really doesn’t get at how we should be thinking about how to treat our patients.” Dr. Patel then shared three different cases to illustrate treatment and management of basal cell carcinoma.

Later in the session, Dr. Michael Marchetti presented, “The Road Ahead: Updates in the Management of Melanoma.” Dr. Marchetti discussed all updates to melanoma, the fifth most common cancer in the United States in 2021. According to Dr. Marchetti, there are over 100,000 cases of invasive melanoma diagnosed each year. However, when identified early, the five-year survival rate is very favorable. And, Dr. Marchetti reported, “The good news is that, since 2013, deaths from melanoma have been rapidly dropping.”

Dr. Marchetti introduced three emerging tools for diagnosis, including the pigmented lesion assay test, a noninvasive molecular test that is an adhesive patch placed on the skin lesion. It can be used at home or at the clinic. He said, “The accuracy of this particular study sensitivity appears to be quite high at 90%.” He added that an economic analysis suggested that if used in the right conditions, this test has the potential to save money and avoid unnecessary biopsies. The second new device used for diagnosis relies on electrical spectroscopy. This tool measures how current flows through individual cells in lesions. Dr. Marchetti said the device provides a numeric score and takes about 30 seconds to assay the lesion. He then revealed a third tool he called the “next-generation total body photography.” He stated, “This is not something clinically validated yet, but we are seeing a lot of progress on this front.” Sharing his optimism for the future, he further stated, “I think there is a lot of progress and things to come in the future. Over the last four years, we have also seen incredible progress in terms of the application of artificial intelligence to skin cancer.”

Also in today’s session were presentations by Dr. Neal Bhatia on “Actinic Keratosis: The Importance of Early Detection and Management,” and Dr. Kishwer Nehal’s presentation, “Expert Perspectives on Managing Patients with High-Risk Cutaneous Squamous Cell Carcinoma.” The session was rounded out by Dr. Ashfaq Marghoob presenting “Seeing Clearer: Dermoscopy Tips and Tricks.”

Before you go, make sure to visit our live Q&A panel here. Also make sure to check out our “Ask the Experts” interactive session with Dr. Ashfaq Marghoob and Dr. Linda Stein Gold, which features case-based discussions submitted by attendees with a focus on acne, rosacea, and cutaneous malignancies.
Jody Small

Don’t miss! The second session of Innovations in Dermatology: Virtual Spring Conference 2021 served as an update on psoriasis. Co-chair Linda Stein Gold shared her thoughts on the day: “Drs. Bruce Strober, Joel Gelfand, Amy Paller, and I discussed the latest therapeutic options for psoriasis and timely hot topics, including treating psoriasis patients in the environment of the COVID-19 pandemic. We had a lively discussion and also provided many pearls for optimizing treatment for our adult and pediatric psoriasis patients.”

 

Innovations in Dermatology Daily – Session 1

During the first dynamic virtual session of Innovations in Dermatology: Virtual Spring Conference 2021, “All You’re Itching to Know About Atopic Dermatitis,” Dr. Jonathan Silverberg explored current topics in oral and topical therapies for atopic dermatitis.
In his presentation, “Current Concepts in Targeted Oral and Topical Therapies for Atopic Dermatitis,” Dr. Silverberg reviewed guidelines for clinicians to use in the Step-up approach to atopic dermatitis (AD) management and introduced some of the newer topical therapies to be approved. 
“Ruxolitinib is not just some emerging pipeline therapy in development,” Dr. Silverberg explained. This is already a drug that has completed phase 3 trials and is likely to be approved any day now.” He continued, “This is really important for us to see that ruxolitinib is more effective potentially than some of the things that we are commonly using.”
Regarding other therapies, Silverberg stated, “The oral JAK-inhibitors are the next wave of options to add to the toolbox. Baricitinib, abrocitinib, and upadacitinib all demonstrated efficacy for skin lesions, itch, pain, sleep disturbance, quality of life, anxiety, and depression.” Dr. Silverberg relayed that some patients showed positive responses within hours or days, and overall patients showed good long-term results. He also shared some common adverse events such as headaches, acne, nausea, and upper respiratory infections.
Additionally in this first session of Innovations in Dermatology: Virtual Spring Conference 2021, Dr. Eric Simpson’s presentation, “Biologics: New and Emerging Agents,” revealed new and emerging agents in this dermatological therapeutic area. “There is a lot of exciting science and innovation taking place right now in biologics,” Dr. Simpson commented. He explained that when considering a systemic treatment if a patient’s condition is not under control, there are several options. “The newest is dupilumab, the only FDA-approved biologic.” He stated, “90 to 95% of patients achieve some clinically relevant response in skin or symptoms, and it provides long-lasting benefits with no new adverse event risks.” Dr. Simpson also said that while tralokinumab has modest efficacy results, it continues to capture more successes beyond week 16 and the drug lebrikizumab also shows promise.
Also in today’s opening session were presentations from Dr. Emma Guttman on “Atopic Dermatitis Pathophysiology” and from Dr. Lawrence Eichenfield on “Atopic Dermatitis in Infants and Pediatric Patients.” You can access them here. Before you go, make sure to visit our live Q & A panel from this session as well here.

 

March 2021

Hot Topics in Dermatology: Discussing PRP and Stem Cells for Hair Loss, Collagen Supplements, and Social Media with Omer Ibrahim, MD, PhD

Innovations in Dermatology is back in your inbox this month with a candid interview with Dr. Omer Ibrahim, who is a dermatologist and cosmetic and laser surgeon, as well as co-director of research, at Chicago Cosmetic Surgery and Dermatology. Dr. Ibrahim and I dove right into several hot topics, including use of platelet-rich plasma (PRP) and stem cells for hair loss, as well as photodamage and scarring, the real role of collagen supplementation in skin rejuvenation, and the benefits and drawbacks of use of social media.
In issue last month we shared key insights from Bruce Strober, MD, on new targeted oral therapies for psoriasis, biologics for psoriasis, the readiness of frontline practitioners having to address psoriasis, and whether COVID has changed his practice. If you missed it, you can find that interview here.
Innovations in Dermatology: Virtual Spring Conference 2021 is a MedscapeLIVE! event from the producers of the Hawaii Dermatology Seminar and Caribbean Dermatology Symposium. With 8 live-streamed sessions over a 5-day period this month and daily oral presentations on selected abstracts and interactive case-based discussion from attendee case submissions, this will be an educational event not to miss. (If you do, however, each session will also be available for immediate on-demand access following the conference.)
In this e-news, don’t miss the Suggested Reading from Dr. Ibrahim. Also, this month’s Derm Resource section will keep you updated with a NEJM article on phase 3 trials of tirbanibulin ointment for actinic keratosis plus a NEJM audio interview, updated AAD guidelines, a CME supplement on topical therapies for psoriasis, a perspective in Cutis on if reimbursement for teledermatology during COVID is here to stay, and an editorial in JAMA Dermatology on shared decision-making in dermatology and the need for more training and resources.
Thank you to Dr. Ibrahim for his critical contribution on what’s new in hair loss and other treatments. 
Don’t forget to check out the Innovations in Dermatology: Virtual Spring Conference 2021 here, and please contact me at [email protected] with comments or suggestions. Thanks for reading!
—Colleen Hutchinson

 
Interview

A Melting Pot: Platelet-Rich Plasma and Stem Cells for Hair Loss, Collagen Supplements, and Social Media 
Omer Ibrahim, MD is a board-certified, fellowship-trained dermatologist and cosmetic and laser surgeon at Chicago Cosmetic Surgery and Dermatology, where he also serves as co-director of research.

Colleen: How are platelet-rich plasma (PRP) and stem cells used to treat hair loss?
Dr. Ibrahim:
Platelet-rich plasma (PRP) is an autologous blood-derived product that contains an increased concentration of platelets suspended in plasma. PRP also contains cytokines, plasma proteins, and growth factors that can all contribute to the stimulation of hair growth. Although large randomized controlled trials are lacking, smaller studies and reports have shown that injectable PRP (when properly concentrated and administered) can stimulate terminal hair growth. In my practice, PRP is seldom offered as a monotherapy treatment; I offer PRP as an adjunct to tried and true medical therapy (minoxidil, spironolactone, finasteride, etc). In fact, when PRP is administered alone, the results can be very tenuous and fleeting without maintenance medical treatment at home. The typical PRP regimen includes 3-4 monthly treatments followed by a single “booster” treatment every 4-6 months. Recently, a few companies have begun to tout the use of injectable mesenchymal-derived “stem cells” as a treatment for hair loss. Given that the evidence for safety and efficacy are lacking, and the treatments are quite costly in comparison to PRP, I do not recommend the use of stem cell therapy yet for my hair loss patients.
 
Colleen: How is PRP used to treat photodamage and scarring?
Dr. Ibrahim:
As discussed earlier, PRP contains a multitude of factors that can stimulate wound healing, tissue growth, neocollagenesis, and angiogenesis. As such, PRP has been microneedled into the skin, injected into the skin, and applied topically following ablative laser therapy. In terms of volumizing the face, PRP is not very effective; in comparison to commercially available soft tissue fillers, PRP has not been shown to provide appreciable lifting and volumizing of the face. For cutaneous rejuvenation (i.e., fine lines, wrinkles, pigmentation, and scarring), PRP may be effective. When injected subdermally, some patients have noted improvement in skin texture. When applied during and after microneedling, studies have demonstrated greater improvements in scarring and photodamage in comparison to microneedling alone. Finally, when applied topically following ablative laser, PRP has been shown in some studies to speed up healing and enhance results. 
 
Colleen: What is the role of collagen supplementation in skin rejuvenation? 
Dr. Ibrahim:
The role of oral collagen supplementation in skin rejuvenation has long been debated among the dermatologic community. In fact, the results of studies examining oral collagen’s effects on the skin are often conflicting. Some studies have demonstrated increased cutaneous hydration, increased elasticity, and decreased rhytides with oral collagen peptide supplementation, while some studies showed no difference in these parameters in comparison to placebo. The issue is that there are no large, randomized controlled trials to study the effect of oral peptides on the skin, and the supplements available vary greatly in dosage, purity, and bioavailability. In addition, these supplements are not regulated by the FDA and their safety profile is unknown. As such, clinicians should approach with caution and consider the available evidence if they suggest collagen peptide supplementation for their patients.
 
Colleen: How would you characterize the benefits and drawbacks of use of social media as a clinician?
Dr. Ibrahim:
Social media has placed the power of marketing and branding in the hands of the individual. Gone are the days of shelling out hundreds, if not thousands, of dollars in order to purchase a print-ad in a newspaper or magazine. A photo or video is captured and stored on a mobile device and, with a few finger taps, is uploaded onto a social media platform to be seen by hundreds of eyes and potential patients. The individual has become the driver of the narrative of their career online, at a relatively low financial cost.
There can be drawbacks to social media. One, especially true for the newer social media platforms, is that the clinician for the first time is much more accessible on a personal level. The debate between what is considered “professional” and “unprofessional” can become muddled. Another drawback to social media is that the clinician finds him or herself competing with other “skin experts” online that in fact have no training in dermatology, and just happen to have a wider fan base. The provider now not only needs to educate patients on what treatments are appropriate for them, but also finds themselves having to demystify myths propagated by the so-called “skin experts” online.

 

Suggested Reading

Article: Wang JV, Schoenberg E, Saedi N, Ibrahim O. Platelet-rich Plasma, Collagen Peptides, and Stem Cells for Cutaneous Rejuvenation. J Clin Aesthet Dermatol. 2020 Jan;13(1):44-9.
https://pubmed.ncbi.nlm.nih.gov/32082473/
Dr. Ibrahim: The use of platelet-rich plasma, collagen supplementation, and stem cells is rapidly expanding and evolving. This article reviews the current evidence, or lack thereof, of these treatment modalities, and is a helpful resource for clinicians that use these therapies in their practice.
 

 

 

February 2021

Hot Topics in Dermatology: Discussing Psoriasis Advances with Bruce Strober, MD, PhD

Innovations in Dermatology is back in your inbox this month with a candid interview with Dr. Bruce Strober, who is Clinical Professor of Dermatology at Yale University School of Medicine and Medscape’s upcoming Innovations in Dermatology: Virtual Spring Conference 2021 faculty. Dr. Strober and I dove right into several hot topics, including the new targeted oral therapies for psoriasis, biologics for psoriasis, the readiness of frontline practitioners having to address psoriasis, and whether COVID has changed his practice.
In our inaugural issue last month we shared key insights from Michael S. Kaminer, MD, Linda Stein Gold, MD, and Lawrence Eichenfeld, MD—co-chairs of Innovations in Dermatology: Virtual Spring Conference 2021, on the microbiome and dermatology, racial disparities in dermatology, how ready and informed our frontline practitioners are in addressing the dermatological cases and conditions that they regularly face, and COVID. If you missed it, you can find that interview here.
Innovations in Dermatology: Virtual Spring Conference 2021 is a MedscapeLIVE! event from the producers of the Hawaii Dermatology Seminar and Caribbean Dermatology Symposium. With 8 live-streamed sessions over a 5-day period in March and daily oral presentations on selected abstracts and interactive case-based discussion based on attendee case submissions, this will be an educational event not to miss. (If you do, however, each session will also be available for immediate on-demand access following the conference.)
In this e-news, don’t miss the Suggested Reading from Dr. Strober. Also, this month’s Derm Resource section will keep you updated with a NEJM article on phase 3 trials of tirbanibulin ointment for actinic keratosis plus a NEJM audio interview, updated AAD guidelines, a CME supplement on topical therapies for psoriasis, a perspective in Cutis on if reimbursement for teledermatology during COVID is here to stay, and an editorial in JAMA Dermatology on shared decision-making in dermatology and the need for more training and resources.
Thank you to Dr. Strober for his critical contribution on wha’s new in psoriasis treatments. 
Don’t forget to check out details for the Innovations in Dermatology: Virtual Spring Conference 2021 here, and please contact me at [email protected] with comments or suggestions. Thanks for reading!
–Colleen Hutchinson

 

Interview

Hot Topics in Dermatology: Psoriasis Advances
Bruce Strober MD, PhD, Clinical Professor of Dermatology at Yale University School of Medicine and Central Connecticut Dermatology. He is currently the Editor in Chief of the Journal of Psoriasis and Psoriatic Arthritis and Co-Scientific Director of the Corrona Psoriasis Registry.

Colleen: We hear a lot now about targeted oral therapies for psoriasis. What’s new in this arena, and is any of it ready for prime time or designation as standard of care?

Dr. Strober: There is much that we don’t know about the relationship of the gut microbiome to skin conditions, and there is fascinating research going on that may give us insights into many of our inflammatory skin disorders and others. But a question of more immediate interest to dermatologists is for whom the skin microbiome mediates disease, and how it may be a target for intervention for disease management (or potentially, avoidance). Atopic dermatitis (AD), for instance, is well known to be associated with colonization with Staph aureus, and that flaring AD has more staph on the skin and less microbial diversity then when AD is calm and controlled. We are learning that some of our new systemic biologic agents affect the microbiome as they minimize inflammation, and several groups of AD researchers are testing whether microbial interventions with strains of non-staph bacteria applied topically may be anti-inflammatory.

Colleen: There is a lot of discussion about biologics for psoriasis as well. What’s new in this arena and is any of it ready for prime time or designation as standard of care?

Dr. Strober: Also approved for systemic-treatment appropriate psoriasis in adults within the next year will be bimekizumab, a biologic that blocks both IL-17A and IL-17F. This is a novel mechanism of action that appears to give this biologic higher efficacy than all previous medications for psoriasis, with 85 to 90% of patients achieving PASI 90 after 16 weeks of therapy. It also looks to be very effective for psoriatic arthritis and hidradenitis suppurativa in early trials. For psoriasis, this drug will likely be self-administered every 4 weeks for the first 3 to 4 doses, and then every 8 weeks thereafter. The safety data look comforting, but there will be a tolerability issue related to candidiasis, mostly oral, which occurs in 10 to 18% of patients in clinical trials. 

Colleen: How would you characterize the general care and readiness of frontline practitioners having to address psoriasis in their patients?
Dr. Strober
: Increasingly over the past decade, dermatologists have become much better at managing more severe skin disease, including psoriasis. The advent of biologic therapy has made us all better medical dermatologists, as the drugs have become increasingly safe and much more effective. The newer drugs about to be approved will only hasten that process.

Colleen: Many have said that COVID has changed the way medicine is practiced. How has COVID changed your practice and what has the biggest challenge been?

Dr. Strober: Our practice has continued forward somewhat like old. While we have instituted common sense, well-known protections for staff and patients, most of us have sidelined teledermatology only for the most appropriate situations, e.g., isotretinoin follow-up visits and patients with very stable skin disease controlled with biologic therapy.

 

Suggested Reading

Article: Recategorization of psoriasis severity: Delphi consensus from the International Psoriasis Council. Strober B, Ryan C, van de Kerkhof P, van der Walt J, Kimball AB, Barker J, Blauvelt A. J Am Acad Dermatol. 2020 Jan;82(1):117-122. 
https://pubmed.ncbi.nlm.nih.gov/31425723/
Dr. Strober: This article is a good update on how we should abandon terms “mild,” “moderate,” and “severe” for how we classify psoriasis.

 

Dermatology Resource Section

Innovations in Dermatology Virtual Spring Conference 2021: March 16–20 
https://na.eventscloud.com/website/20848/

Cutis Article: Reimbursement for Teledermatology During the COVID-19 Public Health Emergency: Change Has Come, But Will It Stay?
https://www.mdedge.com/dermatology/article/235459

NEJM Article: Phase 3 Trials of Tirbanibulin Ointment for Actinic Keratosis
https://www.nejm.org/doi/full/10.1056/NEJMoa2024040

Topical Therapies for Psoriasis: The Revolution in Vehicles, Combinations, and Novel Agents—
A CME/CE Certified Supplement from the Hawaii Dermatology Seminar
https://www.globalacademycme.com

JAMA Dermatology Editorial: Shared Decision-Making in Dermatologic Care—A Call for More Training and Resources
https://jamanetwork.com/journals/jamadermatology/article-abstract/2775500

Dermatology News Conference Coverage: Face masks can aggravate rosacea
From the EADV Congress
https://www.mdedge.com/dermatology/article/234827/rosacea/face-masks-can-aggravate-rosacea

American Academy of Dermatology Association: Office-Based Surgery Clinical Guidelines
https://www.aad.org/member/clinical-quality/guidelines/obs

NEJM Audio Interview: An International Look at Covid-19
https://www.nejm.org/contact-nejm?query=footer

 

 

 

January 2021

Inaugural Issue

Hot Topics in Dermatology: Our Thought Leaders Weigh In

MISS E-News Inaugural Issue

Welcome Innovations In Dermatology E-News. I am excited to take on the management of this new Medscape publication with this inaugural issue! As you will see in this issue and those to come, we have some e-news features in store for you that we think you will find beneficial. 
First, every issue will feature a candid interview with either one or multiple thought leaders in dermatology. In this inaugural issue, I interview Michael S. Kaminer, MD, Linda Stein Gold, MD, and Lawrence Eichenfeld, MD—the three co-chairs of Medscape’s upcoming virtual conference, Innovations in Dermatology: Virtual Spring Conference 2021, and get their thoughts on the microbiome and dermatology, racial disparities in dermatology, how ready and informed our frontline practitioners are in addressing the dermatological cases and conditions that they regularly face, the biggest current challenges in training, and COVID in your practice. These thought leaders bring a critical knowledge of current issues and challenges in dermatology, as well as pulse on current best practices, to both this interview and to the conference that they co-chair. Innovations in Dermatology: Virtual Spring Conference 2021 is a MedscapeLIVE! event from the producers of the Hawaii Dermatology Seminar and Caribbean Dermatology Symposium. With 8 live-streamed sessions over a 5-day period in March—each session including 4-5 faculty presentations plus discussion and live Q&A—and daily oral presentations on selected abstracts and interactive case-based discussion based on attendee case submissions, this will be an educational event not to miss. (If you do, however, each session will also be available for immediate on-demand access following the conference.)
In this e-news, we will also sometimes feature Suggested Readings from the thought leaders interviewed. Experts will provide timely articles with not only their own recommendations of articles to read, but often the critical article takeaways as well. It’s one thing to read a list of what we should be reading, but it’s totally another to get picks from the experts. 
Given the ever-changing nature of dermatology and the current healthcare environment, we are also including a Derm Resource section to keep you updated on critical research, resources, and new developments. Please look to us as a collective resource of all things dermatology. This includes association updates, COVID and other general topic publications, and other helpful dermatology best practices information so you have all you need in one place at your fingertips to stay informed.
Get ready to be engaged and entertained, as well as educated, in the coming months. We have great things in store for you!
Thank you to this month’s interview participants and upcoming meeting faculty, Michael S. Kaminer, MD, Linda Stein Gold, MD, and Lawrence Eichenfeld, MD. Don’t forget to check out details for the Innovations in Dermatology: Virtual Spring Conference 2021 here.
Here’s to a new Medscape tool designed to keep you plugged in and informed, to the new names and faces you will see in these issues, and to developing a lasting rapport with you, the readership! We want to be your go-to source of information in all things dermatology. Please contact me at [email protected] with any comments and/or suggestions.
Colleen Hutchinson

 
Interview

Hot Topics in Dermatology: Our Thought Leaders Weigh In
Dr. Kaminer is currently Associate Clinical Professor of Dermatology, Yale Medical School, and Adjunct Assistant Professor of Medicine (Dermatology) at Brown Medical School and is team dermatologist for the Boston Celtics.
Dr. Stein Gold is Director of Dermatology Clinical Research for the Henry Ford Health System in Detroit, Michigan. She is also Division Head of Dermatology for the Henry Ford Health System in West Bloomfield, Michigan.
Dr. Eichenfield is Distinguished Professor of Dermatology and Pediatrics, Chief of Pediatric Dermatology and Vice-Chair of the Department of Dermatology at the University of California, San Diego and Rady Children’s Hospital. 

Colleen: We hear a lot now about the microbiome and its effects in all aspects of medicine. How would you characterize the connection between gut and skin as it pertains to your patient base, and is there new current research and/or treatments on the horizon that will target this connection?

Dr. Eichenfield: There is much that we don’t know about the relationship of the gut microbiome to skin conditions, and there is fascinating research going on that may give us insights into many of our inflammatory skin disorders and others. But a question of more immediate interest to dermatologists is for whom the skin microbiome mediates disease, and how it may be a target for intervention for disease management (or potentially, avoidance). Atopic dermatitis (AD), for instance, is well known to be associated with colonization with Staph aureus, and that flaring AD has more staph on the skin and less microbial diversity then when AD is calm and controlled. We are learning that some of our new systemic biologic agents affect the microbiome as they minimize inflammation, and several groups of AD researchers are testing whether microbial interventions with strains of non-staph bacteria applied topically may be anti-inflammatory.

Dr. Stein Gold: We are starting to understand the role of the microbiome in acne and the impact that our treatment has on it. Cutibacterium acnes (formerly Propionibacterium acnes) is a gram-positive, anaerobic bacteria that normally occupies the hair follicles and sebaceous glands. C. acnes has a role in the pathogenesis of acne. We now understand that it may be the particular strain of bacteria and not the amount of bacteria that influences acne. We know that our treatments, including the use of oral and topical antibiotics, also influence both the microbiome on the skin and in the gut. In order to minimize the impact on the gut, we try to use narrow spectrum antibiotics when treating acne. Also, by treating topically, we can avoid systemic antibiotic influence. 

Colleen: Many have said that COVID has changed the way medicine is practiced. Do you see this in dermatology, and if so, how? Will these be short-term or lasting changes?

Dr. Stein Gold: Teledermatology has enabled us to stay connected to our patients even in times of crisis. Many dermatologists adopted this for the first time during the pandemic but will likely continue to offer this service in the future. Although nothing takes the place of a face-to-face visit, telemedicine can be extremely useful in select cases.

Dr. Eichenfield: The most acute change, and the one that I think will have transformative impact, is the speeding up of adoption of telemedicine in dermatology by years. At our center, we have a strong interest in teledermatology, and had set up consultative dermatology for our emergency department, for instance, but hadn’t set up ‘direct to patient’ services. Within several days of recognition on the pandemic and the rapid shutting down of most clinic-based services, we transformed most of the practice into teledermatology. It was interesting to be “thrown into the deep end of the pool,” and we learned quite a lot within weeks about the pleasures and limitations of virtual visits. We have now learned for what kinds of visits it works well, for what kinds of conditions it doesn't, and the differences in visit preparation and execution between successful in-person “live” vs. teledermatology visits. Many patients so appreciate the convenience of virtual visits, though I would much rather mix and match over time between in clinic and teledermatology services for each patient, as the establishment of the doctor/patient (or family, in pediatrics) relationship is much easier in person.

Dr. Kaminer: COVID has obviously had a profound impact on the practice of medicine, including dermatology. Fortunately, dermatologists were at the forefront of developing strategies to keep our patients and staff safe during the pandemic, enabling in-person visits to resume safely. Telemedicine initially became a mainstay of care, but with the resumption of in-person visits, telemedicine has taken on a lesser role. We envision telemedicine to remain an adjunct to care, particularly with follow-up or maintenance of care visits including acne, eczema, etc. There may be a role for telemedicine as we move forward in dermatology, which will be refined based on efficiency and efficacy of care, as well as policies relating to HIPAA and insurance coverage. 

Colleen: How would you characterize the current racial disparities in dermatology? Is there disparity in diagnosis and treatment based on factors such as lack of use of dark skin in medical training, inadequate training regarding differences in skin conditions based on ethnicity and skin color, and general gaps in research?

Dr. Stein Gold: We have a lack of diversity in both physicians and in education. Although racial and ethnic minority physicians are underrepresented in medicine overall, this is especially pronounced in dermatology, with Black and Hispanic doctors each accounting for under 5% of the workforce. In addition, dermatology textbooks generally show skin conditions on Caucasian skin. In clinical trials with new medications, we have minority patients underrepresented. This is a problem in that we do not obtain enough data to ensure that a particular medication works in a similar way in all patient groups. As a specialty, we are working to improve this in all areas.

Colleen: What do you think will help solve the conundrum of frontline practitioners regularly having to address (common and uncommon) skin conditions and disorders that they do not know how to treat or, even in many cases, properly diagnose? 

Dr. Eichenfield: I think that educating primary care practitioners is crucial to improve care across the spectrum of healthcare delivery. I have been fortunate to have been involved in several projects where we have partnered with our affiliate pediatricians to improve their knowledge and care of certain common dermatology conditions, with great success. They still refer patients regularly with the diseases we have worked on, but the patient selection is better, and the therapies initiated before referral have helped them figure out who would benefit from specialist input. There is much work to do to improve education at the medical school and residency levels for non-dermatologists. 

Colleen: What is/are the biggest current challenges in training in your area of dermatology?

Dr. Kaminer: Cosmetic dermatology continues to experience robust growth, with the development of improved products and techniques. However, it is essential that hype doesn’t outpace science. Cosmetic dermatology was built on the foundation of scientific integrity, and the public has come to expect and trust that our profession will maintain that standard. Failure to adhere to scientific principles, allowing anecdotal evidence or social media to sway opinion, is a recipe for long term problems. Furthermore, it is essential that proper training remain the bedrock of cosmetic dermatology. Dermatology residency programs have improved and expanded cosmetic training, which will help propel the field forward with thought leaders. Non-dermatology cosmetic providers must adhere to and demonstrate similar training and competence if we are to maintain the high level of skill and trust that is central to our mission. The profession must monitor itself to ensure that we hold each of our colleagues to the high standards that are essential to the safe and effective practice of cosmetic dermatology. 

Colleen: Do you find noncompliance to be an issue, and if so, do the implications of that go beyond aesthetic repercussions to affect practices in terms of revenue and also reputation?

Dr. Kaminer: It is the ethical responsibility of healthcare providers to be appropriately trained and skilled when performing any procedure. This also applies to cosmetic dermatology and is one of the most important issues facing the profession today. Complications and sub-optimal results can be the byproduct of inadequate training, and it is incumbent on all providers, whether they are dermatologists or not, to ensure that they meet the standards set by the industry. Compliance with this basic tenet of medical practice is simply essential. Dermatology has been a leader in training, innovation, and the practice of cosmetic procedures, and the field has benefitted tremendously. If we wish to continue to lead the way, then dermatology as a specialty must ensure that we hold our profession to the same high standards that have been our foundation. Failure to do so will likely lead to an erosion of public trust, and a collective decrease in the standard of care. All of this is avoidable with proper education and training, and dermatology must insist that our non-dermatology colleagues follow these same principles.

 
Suggested Readings

Article: Insights into the Pathophysiology of Cellulite: A Review. Bass LS, Kaminer MS. Dermatol Surg. 2020 Oct;46 Suppl 1(1):S77-S85.
https://pubmed.ncbi.nlm.nih.gov/32976174/
Dr. Kaminer: This is a thorough review of cellulite, with novel insights as to pathogenesis and treatment.

Article: The role of the skin microbiome in atopic dermatitis. Nakatsuji T, Gallo RL.
Ann Allergy Asthma Immunol. 2019;122(3):263-269. 
https://pubmed.ncbi.nlm.nih.gov/30550810/
Dr. Eichenfield: This is an interesting article discussing the interrelationship of the microbiome with our most common inflammatory skin disease.

Article: Update on pediatric atopic dermatitis. Tracy A, Bhatti S, Eichenfield LF. Cutis. 2020 Sep;106(3):143-146.
https://pubmed.ncbi.nlm.nih.gov/33104117/
Dr. Eichenfield: There is a rapid evolution of therapy in atopic dermatitis. This article discusses new aspects of epidemiology and new therapies for pediatric eczema. 

 
Dermatology Resource Section

Highlights of the 43rd Annual Hawaii Dermatology Seminar (CME/CE Certified Supplement)
https://www.globalacademycme.com

Journal of the American Academy of Dermatology: Joint AAD–NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures
https://www.jaad.org/article/S0190-9622(20)32288-X/fulltext

Medical Intelligence Quiz—Challenge Yourself, Build Your Knowledge: Actinic keratosis—Are shorter ALA incubation periods effective?
https://www.mdedge.com/dermatology/actinic-keratosis

JAMA Dermatology Article: Enanthem in Patients With COVID-19 and Skin Rash:
https://jamanetwork.com/journals/jamadermatology/fullarticle/2768252

Innovations in Dermatology: Virtual Spring Conference 2021: March 16–20:
https://na.eventscloud.com/website/20848/

NEJM Perspective: Testing in a Pandemic — Improving Access, Coordination, and Prioritization:
https://www.nejm.org/doi/full/10.1056/NEJMp2025173?query=featured_home