88 episodes

Stay current on medical, surgical, and aesthetic dermatology developments with Dermatology Weekly, a podcast featuring news relevant to the practice of dermatology, and peer-to-peer interviews with Doctor Vincent A. DeLeo, who interviews physician authors from Cutis on topics such as psoriasis, skin cancer, atopic dermatitis, hair and nail disorders, cosmetic procedures, environmental dermatology, contact dermatitis, pigmentation disorders, acne, rosacea, alopecia, practice management, and more. Plus, resident discussions geared toward physicians in-training. Subscribe now.

The information in this podcast is provided for informational and educational purposes only.

Dermatology Weekly MDedge

    • Medicine

Stay current on medical, surgical, and aesthetic dermatology developments with Dermatology Weekly, a podcast featuring news relevant to the practice of dermatology, and peer-to-peer interviews with Doctor Vincent A. DeLeo, who interviews physician authors from Cutis on topics such as psoriasis, skin cancer, atopic dermatitis, hair and nail disorders, cosmetic procedures, environmental dermatology, contact dermatitis, pigmentation disorders, acne, rosacea, alopecia, practice management, and more. Plus, resident discussions geared toward physicians in-training. Subscribe now.

The information in this podcast is provided for informational and educational purposes only.

    Should psoriasis patients continue biologics during the COVID-19 pandemic? Plus CMS implements changes to aid the COVID-19 response

    Should psoriasis patients continue biologics during the COVID-19 pandemic? Plus CMS implements changes to aid the COVID-19 response

    Patients with severe psoriasis may be at higher risk for infection because of increased inflammation in the body. Dr. Lawrence Green discusses how to counsel patients who are taking biologics to control their psoriasis during the COVID-19 pandemic. “What I recommend [is to] stay on your biologic as long as you can unless you have exposure [or] you start to feel feverish,” Dr. Green advises.
    *  *  *  
    We also bring you the latest in dermatology news and research:
    1. CMS implements temporary regulatory changes to aid COVID-19 response
    2. FDA issues EUA allowing hydroxychloroquine sulfate, chloroquine phosphate treatment in COVID-19
    3. FDA okays emergency use of convalescent plasma for seriously ill COVID-19 patients
    4. Physician couples draft wills, face tough questions amid COVID-19
    *  *  *  
    Key takeaways from this episode:
    Patients with uncontrolled psoriasis symptoms are at higher risk for developing infection and other comorbidities. “In general, I have told patients that if they stop the biologic for some time and the psoriasis comes back so that it’s severe again, I think that it’s significantly more risky for getting COVID-19 than if they continue to take their biologic,” says Dr. Green. There currently are no data on whether biologics help or harm patients with COVID-19. Anti–tumor necrosis factor (anti-TNF) agents may be useful in helping control pneumonia, but they also are associated with an increased risk for infection, compared with other biologic agents. It may be safer for patients to switch to or continue treatment with anti–IL-17 or anti–IL-23 agents during the COVID-19 pandemic. Patients should stop biologic treatment if they have exposure to someone with COVID-19 or start to show symptoms. “Stopping a biologic for a few weeks will not bring your psoriasis back. ... [but] a few months off can make a difference,” Dr. Green explains. Patients currently on biologics should take extra precautions to practice social distancing, stay at home when possible, wash hands, use hand sanitizer, and avoid touching the face, as recommended by the Centers for Disease Control and Prevention. For additional resources, dermatologists can consult the American Academy of Dermatology or the National Psoriasis Foundation guidelines on psoriasis treatment during the COVID-19 pandemic. *  *  *  
    Host: Nick Andrews
    Guest: Lawrence J. Green, MD (George Washington University, Washington)
    Show notes by: Alicia Sonners, Melissa Sears
    *  *  *  
    You can find more of our podcasts at http://www.mdedge.com/podcasts     
    Email the show: podcasts@mdedge.com
    Interact with us on Twitter: @MDedgeDerm

    • 12 min
    AAD’s COVID-19 advice; how to start teledermatology; and handoff tips for dermatology residents

    AAD’s COVID-19 advice; how to start teledermatology; and handoff tips for dermatology residents

    In residency, transitioning care to different providers can be a complicated process. Dr. Vincent DeLeo talks to Dr. Sophie Greenberg about strategies to improve patient handoffs among dermatology trainees. Dr. Greenberg identifies key issues that may hinder patient handoffs and poses evidence-based solutions that can help keep dermatology residents organized.
    * * *  
    We also bring you the latest in dermatology news and research:
    1. Coronavirus resources from AAD target safe office practices, new telemedicine guidance
    AAD President George J. Hruza, MD, assured members that AAD will maintain updated resource pages in a situation that’s changing by the day.
    2. How to ramp up teledermatology in the age of COVID-19
    Dr. Adam Friedman discusses the steps his institution is taking to prepare for more virtual visits.
    *  *  *  
    Things you will learn in this episode:
    Handoff problems are one of the top issues that are more prevalent in malpractice cases involving medical trainees vs nontrainees. Issues with handoffs occur between trainees as well as between trainees and attendings. “Communication skills may be underemphasized in residency, with lack of formal teaching on this matter,” Dr. Greenberg notes. Many electronic medical records have built-in functions to assist with patient handoffs, and there also are several HIPAA-compliant electronic apps that can help providers collaborate and stay organized. Mnemonics and other standardized tools that have proven effective in internal medicine inpatient settings may be easily implemented in the dermatology setting. “I also keep a notebook with stickers of each patient I see and jot down things to follow up. At the end of each day, I double check and periodically update my electronic handoff,” Dr. Greenberg explains. *  *  *
    Hosts: Nick Andrews; Vincent A. DeLeo, MD (University of Southern California, Los Angeles)
    Guests: Sophie A. Greenberg, MD (Columbia University Medical Center, New York); Adam Friedman, MD (George Washington University, Washington)
    Show notes by: Alicia Sonners, Melissa Sears
    *  *  *  
    You can find more of our podcasts at http://www.mdedge.com/podcasts     
    Email the show: podcasts@mdedge.com
    Interact with us on Twitter: @MDedgeDerm

    • 15 min
    COVID-19: What Dermatologists should know, plus how to use the Fitzpatrick skin type classification?

    COVID-19: What Dermatologists should know, plus how to use the Fitzpatrick skin type classification?

    The Fitzpatrick skin type (FST) often is used as a proxy for constitutive skin color, which can lead to confusion. Dr. DeLeo speaks with Dr. Susan Taylor and her colleagues Olivia Ware and Jessica Dawson about the racial limitations of FST in clinical practice. They discuss other classification systems for assessment of skin type and highlight the challenges of creating one system to classify an infinite number of skin tones.
    * * *  
    We also bring you the latest in dermatology news and research:
    1. Paper from Wuhan on dermatology and coronavirus
    2. Patients accept artificial intelligence in skin cancer screening

    3. Dermatologists best at finding work satisfaction in the office
    *  *  *  
    Things you will learn in this episode:
    In its early stages, the Fitzpatrick scale was designed to guide dosage for patients undergoing phototherapy by determining who burned and who tanned on exposure to UV light. The Fitzpatrick skin type has been incorrectly associated with visual stereotypical skin color cues, most likely because there is no other widely adopted classification system for skin color that can be applied to all skin. In clinical practice, many providers inappropriately use the FST to describe patients’ constitutive skin color or race/ethnicity rather than their propensity to burn. The FST is automatically included in the physical examination portion of many standardized note templates, even for patients without phototherapy needs. Providers who do not identify as having skin of color may be more likely to use FST to describe constitutive skin color, compared with providers with skin of color. A more detailed and diverse system to describe constitutive skin color in clinical practice is needed. “The world is becoming so diverse, and there are so many different hues, races, ethnicities, and as dermatologists in the forefront we need to be able to identify pigmentary disorders, identify who will have adverse reactions to a variety of procedures, and thinking about how to do that is really the first step in accomplishing our goal,” explains Dr. Taylor. *  *  *
    Hosts: Nick Andrews; Vincent A. DeLeo, MD (University of Southern California, Los Angeles)
    Guests: Susan C. Taylor, MD (University of Pennsylvania, Philadelphia); Olivia R. Ware (Howard University, Washington); Jessica E. Dawson (University of Washington, Seattle)
    Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie
    *  *  *  
    You can find more of our podcasts at http://www.mdedge.com/podcasts     
    Email the show: podcasts@mdedge.com
    Interact with us on Twitter: @MDedgeDerm

    • 25 min
    Treatment adherence to topicals for psoriasis, plus coronavirus prompts cancellation of AAD

    Treatment adherence to topicals for psoriasis, plus coronavirus prompts cancellation of AAD

    Consider poor adherence rather than recalcitrant disease in psoriasis patients who do not respond to topical treatment. Dr. Vincent DeLeo talks with Dr. Nwanneka Okwundu and Dr. Steven Feldman about strategies to promote better treatment adherence. They discuss factors that contribute to poor adherence and offer tips to motivate patients to stick to their treatment regimens. “There’s a lot we can do to get people to use their medicine better.  ... Our job is to get people well. And to do that, we have to make the right diagnosis, prescribe the right therapy, and do those things that need to be done to get patients to put the medicine on,” explains Dr. Feldman.
    * * *  
    We also bring you the latest in dermatology news and research:
    1. Coronavirus outbreak prompts cancellation of AAD annual meeting
    The American Academy of Dermatology annual meeting is the latest large medical conference to be canceled because of the coronavirus disease 2019 (COVID-19) outbreak.
    2. Antifungal drug terbinafine appears safe for pregnancy
    Treatment with terbinafine during pregnancy does not appear to increase the risk of major malformations or spontaneous abortions.
    3. Toys may be the culprit for children with contact allergies
    A variety of toys such as video game controllers, tablets, dolls, bikes, and toy cars, can cause contact dermatitis in children because of the nature of their respective ingredients.
    *  *  *  
    Things you will learn in this episode:
    A recent study evaluated whether psoriasis patients who were resistant to topical corticosteroids responded under conditions designed to promote treatment adherence, which included telephone reminders, frequent study visits, and use of a spray vehicle vs. an ointment. Most participants improved in all measurement parameters, but the randomized group of patients who received telephone calls showed more improvement in disease severity than those who did not receive telephone calls. “This idea that topical therapy doesn’t work, I think, is based on a misconception. It’s based on our observations that it doesn’t work, but we’re not seeing how poorly compliant patients are. If we take people who fail topical therapy and do things to really get them to use their topical medication well, their skin disease clears up,” Dr. Feldman explains. In addition to making the diagnosis and prescribing treatment, dermatologists play an important role in getting psoriasis patients to use their medications: “If you tell people, ‘Here, put this topical therapy on. It’s messy, I’ll see you in 3 months,’ you’ll be like a piano teacher saying, ‘Here’s a really complicated piece of music, practice it every day, I’ll see you at the recital in 3 months.’ It’s just not going to sound like a very good recital,” Dr. Feldman notes. Practical alternatives to frequent office visits that dermatologists can use to answer patient questions and promote treatment adherence include virtual visits (teledermatology) and electronic interactions (telephone calls, email correspondence). It is important to prescribe therapies that are consistent with a patient’s preferred vehicle. “If the patient prefers a spray, give them a spray. If they want an ointment, give them an ointment. They are more likely to use it that way,” Dr. Okwundu recommends. When starting patients on a new treatment, hold them accountable by having them check in with you to let you know how they are doing. “Maybe we don’t need to see people every 3 days, but we need to make sure patients realize we care about them, because they don’t want to let us down if we have the kind of strong human relationship with them and then we have to hold them accountable,” Dr. Feldman advises. *  *  *  
    Hosts: Nick Andrews; Vincent A. DeLeo, MD (University of Southern California, Los Angeles)
    Guests: Nwanneka O

    • 17 min
    Hyperbaric oxygen therapy in dermatology, plus nemolizumab tames itching in prurigo nodularis patients

    Hyperbaric oxygen therapy in dermatology, plus nemolizumab tames itching in prurigo nodularis patients

    Hyperbaric oxygen therapy (HOT) is an effective second-line treatment option anytime there is a chronic complicated wound or tissue with vascular compromise. Dr. Josephine Nguyen, president of the Association of Military Dermatologists, talks with Dr. Emily Wong and Dr. Jonathan Jeter about how dermatologists can use HOT. “The most common scenario ... would be a situation where you have a compromised flap or graft after a surgery,” says Dr. Jeter “[The site is] not getting enough blood flow that’s threatening it to necrose ... hyperbaric oxygen therapy can come in [and] can increase the oxygen delivery to those sites,” says Dr. Jeter. They discuss the mechanism of action for HOT, tips for treatment, and potential complications.
    * * *  
    We also bring you the latest in dermatology news and research:
    1. What medical conferences are being canceled by coronavirus?
    Despite COVID-19, most U.S. medical conferences are moving forward as planned.
    2. Nemolizumab tames itching in prurigo nodularis patients in phase 2 study
    Adults with moderate to severe prurigo nodularis who were treated with the investigational drug nemolizumab showed significant improvement in itching, compared with patients who received placebo.
    3. Esophageal stricture signals urgent treatment in kids with butterfly skin
    A quarter of urgent contacts in 20 children with generalized severe recessive dystrophic epidermolysis bullosa were tied to esophageal narrowing.
    * * *  
    Things you will learn in this episode:
    Hyperbaric oxygen therapy is best known for treating decompression sickness (e.g., "the bends" in scuba divers or aircrew members) and carbon monoxide poisoning. “[HOT] occurs in a specialized chamber that gradually becomes pressurized in order to increase the ambient pressure,” Dr. Wong explains. “Then the pressure can return to atmospheric pressure in a controlled, slow manner.” In addition to persistent wounds and compromised grafts and flaps, other dermatologic applications for HOT include radiation-induced ulceration, vasculitis/vasculopathy, and autoimmune reactions. Patients may inquire about HOT for anti-inflammatory conditions such as psoriasis, but there currently is no evidence to support its effectiveness. Only published dermatologic indications for HOT are recommended until more research is conducted. According to the Undersea & Hyperbaric Medical Society, there currently are nearly 200 accredited HOT locations in the United States. Hyperbaric oxygen therapy is most likely to be available within large medical centers and is less common in rural areas. In cases in which tissue is threatened, it is important to refer patients for HOT sooner rather than later. “The longer it goes since the initial injury or loss of blood flow, the less likely [HOT is] going to be effective,” notes Dr. Jeter. Dermatologists typically need to refer patients to large academic medical centers with wound care centers to receive HOT. Potential complications of HOT include fire, middle ear barotrauma, and reversible myopathy. More severe but rare complications include central nervous system symptoms, seizures, and pulmonary toxicity. The only absolute contraindication for HOT is an untreated pneumothorax. Treatment sessions can last anywhere from a few minutes up to several hours. “The longer [the sessions] get, the more likely you are to have complications, but generally around an hour to an hour and a half is a pretty reasonable time period,” Dr. Jeter recommends. In a hyperbaric oxygen chamber, the patient sits or lays down and breathes in pressurized 100% oxygen through a mask or a tight-fitting hood, and the affected skin stays covered with a bandage or the patient’s clothing. “Ultimately, it is the increased level of systemic oxygen that promotes wound healing and graft or flap survival. The systemic oxygen improves the

    • 25 min
    Anti-inflammatory effects of low-dose naltrexone, plus morning and evening skin protection

    Anti-inflammatory effects of low-dose naltrexone, plus morning and evening skin protection

    Low-dose naltrexone can suppress inflammatory markers, making it a potential therapy for some inflammatory skin conditions with a pruritic component. In this resident takeover, Dr. Daniel Mazori talks to Dr. Nadine Shabeeb about the benefits of off-label low-dose naltrexone (LDN) for the treatment of inflammatory skin conditions. “These anti-inflammatory effects aren’t seen at the higher doses of naltrexone; they’re only seen at the lower dose,” Dr. Shabeeb notes. She provides a practical perspective on prescribing LDN in the dermatology setting and discusses how to counsel patients about potential side effects, including concerns about its abuse potential.
    * * *  
    We also bring you the latest in dermatology news and research:
    1. Advising patients on morning and evening skin protection
    MDedge Dermatology Editor Elizabeth Mechcatie speaks with Dr. Brooke C. Sikora about what clinicians can recommend for their patients for skin protection, both in the morning and in the evening.
    2. Patient counseling about expectations with noninvasive skin tightening is key
    Dr. Nazanin Saedi advised that it is important to counsel patients about the degree of improvement to expect with noninvasive skin-tightening procedures.
    3. Banning indoor tanning devices could save lives and money
    Banning indoor tanning devices outright in the United States, Canada, and Europe could prevent as many as 448,000 melanomas and save billions of dollars.
    * * *  
    Things you will learn in this episode:
    Naltrexone is approved by the U.S. Food and Drug Administration to treat alcohol and opioid addiction. At its approved dose of 50-100 mg/day, naltrexone blocks opioid effects for 24 hours. In dermatology, naltrexone is used off-label at lower doses of 1.5-4.5 mg/day. “At this dose, naltrexone only binds partially to the opioid receptors, so this ends up leading to a temporary opioid blockade and ultimately increases endogenous endorphins.” Dermatologic conditions that may benefit from LDN include Hailey-Hailey disease, lichen planopilaris, psoriasis, and pruritus. Low-dose naltrexone has a favorable side-effect profile. Known adverse effects include sleep disturbances with vivid dreams and gastrointestinal tract upset. Low-dose naltrexone can alter thyroid hormone levels, especially in patients with a history of thyroid disease. “If they haven’t had a normal TSH [thyroid-stimulating hormone test] in the past year, then you can consider checking one at baseline and then check every 3 or 4 months for patients who do have a history of thyroid disease while they’re on treatment,” Dr. Shabeeb advises. “I’d also recommend counseling patients about symptoms related to hyper- and hypothyroidism so that they’re aware of symptoms to look out for.” There is no known abuse potential for LDN, but it is important to ask patients if they are using any opiates or opioid blockers before prescribing it. “If [LDN is] taken with an opiate, it can cause withdrawal symptoms and also decrease the effectiveness of the opiate, and if it’s taken with other opioid blockers, there’s also a higher risk for opioid withdrawal,” Dr. Shabeeb explains. Patients should be counseled that the cost of LDN will not be covered by insurance because it has no FDA-approved dermatologic indications. There is a lot of potential for LDN in the treatment of inflammatory skin diseases, but current research is limited to case report and case series; therefore, more data is needed. * * * 
    Hosts: Nick Andrews; Daniel R. Mazori, MD (State University of New York, Brooklyn)
    Guests: Nadine Shabeeb, MD, MPH (University of Wisconsin Hospital and Clinics, Madison); Brooke C. Sikora, MD, is in private practice in Chestnut Hill, Pa.; Nazanin Saedi, MD (Jefferson University Hospitals, Philadelphia
    Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie
    *

    • 22 min

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