Derms and Conditions Dermsquared

In this episode of Derms and Conditions, host James Q Del Rosso, DO, is joined by Shawn Kwatra, MD, to discuss an intriguing breakthrough in atopic dermatitis (AD) therapeutics: the OX40/OX40 ligand pathway. As advancements in AD treatment continue to unfold rapidly, this pathway has emerged as a novel target, presenting a promising avenue for achieving long-term relief by targeting upstream inflammatory signals. By normalizing disease processes and potentially inducing longer periods of remission, understanding this pathway may offer a paradigm shift in AD management.
They begin with an overview of the OX40/OX40 ligand pathway, a key regulatory mechanism believed to govern type 2 inflammation at its source. The OX40/OX40 ligand serves as a crucial costimulatory molecule, facilitating communication between immune cells. This interaction, occurring upstream in the inflammatory cascade, has become the focus of therapeutic interventions aimed at modulating AD.
They also highlight the impact of the heterogeneity of AD, characterized by various cytokine profiles and immune responses, emphasizing the significance of targeting the OX40/OX40 ligand pathway. By intervening at this early stage, it becomes possible to personalize treatment strategies and address the diverse manifestations of the disease.
They then discuss the potential of OX40/OX40 ligand modulation to influence immune memory, leading to sustained responses even after treatment cessation. Clinical data suggest the possibility of extended remission periods, enabling a shift towards disease modification rather than symptom control alone.
Looking ahead, the pair discusses how the integration of OX40/OX40 ligand-targeted therapies with existing treatments could yield synergistic effects, expanding treatment options for not only AD but also related inflammatory conditions.
Tune in to the full episode to learn more about this novel target and how it may revolutionize the management of a spectrum of immune-mediated diseases.
This episode is supported by Sanofi. The content included in this episode is independently developed by the Derms and Conditions team and their guest speakers, and reflects their own views and opinions.

In this episode of Derms and Conditions, host James Q Del Rosso, DO, interviews Faranak Kamangar, MD, and April Armstrong, MD, MPH, about the integration of artificial intelligence (AI) in dermatology. They discuss specialized dermatologic models, ethical considerations, and the crucial role of physicians in refining these technologies.
The discussion begins with the host addressing concerns regarding the "authenticity" of AI and how Dr Kamangar developed a strong interest in AI, stemming from her engineering background and interest in health technology, particularly in the development of language-learning models. She explains the significance of ChatGPT opening the door publicly for AI, followed by specialized models revolutionizing AI accuracy. They then discuss the vetting process for AI accuracy, addressing both anticipated and logical errors and the more subtle errors seen in field-specific results. Dr Kamangar emphasizes the importance of using specialized AI models for dermatology to ensure the most precise results.
The discussion with both Dr Kamangar and Dr Armstrong also touches on the ethical considerations surrounding AI use in medical writing, highlighting the necessity of disclosing AI involvement to uphold integrity in academic publishing. Exploring the use of AI in electronic medical records (EMRs), Dr Kamangar and Armstrong underscore the importance of maintaining HIPAA compliance and the need for human oversight when integrating AI into EMRs and publications. They note that when implemented effectively, AI use in EMRs has the potential to reduce human errors, and with both medical record documentation and publication writing, has the potential to alleviate burnout.
The conversation then shifts to the role of residents in integrating AI tools into their practice, with Dr Armstrong noting that residents are often early adopters of new technologies. They also emphasize the importance of physician involvement in the early development of dermatology-specific AI solutions, which is essential for shaping tools that address real-world challenges in dermatologic practice.
Looking forward, they both anticipate continued integration of AI in dermatology practice, emphasizing the need for physicians to familiarize themselves with this technology to determine what models are dependable and ultimately to optimize patient care.
Tune into the episode to further explore the many nuanced challenges and opportunities presented by AI adoption in dermatology!

In this episode of Derms and Conditions, host James Q Del Rosso, DO, engages in a comprehensive discussion with Jason Hawkes, MD, MS, FAAD, a medical dermatologist in Rocklin, CA, on chronic spontaneous urticaria (CSU). They discuss CSU’s position in the spectrum of urticarial conditions, explore differential diagnoses and treatment strategies, and offer a wealth of valuable insights into this complex disease.
They begin by defining urticaria as a collection of conditions, explaining that this is often not well-delineated in textbooks or literature. Dr Hawkes categorizes urticaria into acute and chronic types, with chronic further divided into chronic inducible urticaria, which results from an identifiable trigger, and chronic spontaneous urticaria, which has no clear cause.
They then explore differential diagnoses for CSU, including drug-induced urticarial reactions and conditions like mastocytosis or urticarial bullous pemphigoid that require thorough consideration.
Transitioning to treatment strategies, they evaluate the use of systemic corticosteroids like prednisone for short-term relief in patients with CSU, taking into account reservations about long-term efficacy and potential side effects. Antihistamines are also highlighted for their rapid action, with Dr Hawkes encouraging prompt dosage adjustments if initial doses are ineffective.
The conversation shifts to omalizumab, an injectable anti-IgE monoclonal antibody that has waned in popularity among dermatologists due to practical limitations and concerns over anaphylaxis risk. However, it is highlighted as a very effective treatment option for many patients with CSU, as it is amenable to office administration with low rates of anaphylaxis in real-world practice and has a broad consensus for use in guidelines.
They conclude by touching on newer therapies in development that target alternative mechanisms, such as BTK and SYK inhibitors, which will broaden the therapeutic alternatives for patients with CSU.
Tune into the full episode to gain a deeper understanding of CSU and glean invaluable insights into the nuances of this multifaceted condition.

In this episode of Derms and Conditions, host James Q Del Rosso, DO, interviews Naiem Issa, MD, PhD, FAAD, a dermatologist and dermatologic surgeon practicing at Forefront Dermatology in Vienna, VA, to discuss innovative approaches to treating challenging conditions. From exploring groundbreaking treatments for vitiligo to the mechanisms behind systemic responses in inflammatory diseases, this episode offers valuable insights into the intersection of art and science in dermatology.
The conversation begins with a focus on a novel combination treatment for a challenging disease state: vitiligo. Dr Issa explores the potential of combining topical ruxolitinib with microneedling to promote repigmentation. He explains the rationale behind this approach, citing the proinflammatory cytokine milieu induced by microneedling, which can promote melanogenesis and repigmentation. He shares a successful case study involving a pediatric patient with segmental vitiligo who, after failing multiple other therapies, achieved significant repigmentation after undergoing this combined treatment.
The discussion then shifts to Dr Issa's experiences with observing responses in untreated areas of inflammatory disease after treating a specific area. They consider the possible mechanisms of action behind this phenomenon and discuss the case of pediatric patient with severe atopic dermatitis who saw improvement in untreated areas after applying tapinarof to symptomatic areas, suggesting a possibly systemic anti-inflammatory effect mediated by regulatory T cells.
Their discussion concludes by addressing the critical unmet need in the supply chain for epinephrine and the impact on clinical practice where lidocaine with ephinephrine is necessary for local anesthetic use. They discuss midodrine, an alpha-1-specific agonist, as an alternative to epinephrine, with findings indicating that midodrine allows for the reduction of epinephrine needed in lidocaine combinations and the significant effects observed at lower dilutions.
Tune in to the full episode to hear more about Dr Issa’s innovative approaches, groundbreaking research, and cutting-edge strategies that address critical needs in dermatology!

In this episode of Derms and Conditions, host James Q Del Rosso, DO, sits down with Jennifer Hsiao, MD, associate professor of clinical dermatology at Keck Medicine of University of Southern California, to discuss the multifaceted world of hidradenitis suppurativa (HS). From addressing diagnostic obstacles to understanding comorbidities, this episode guides clinicians through the many complexities of HS management.
They begin by exploring the diagnostic hurdles associated with HS, with Dr Hsiao sharing insights to help clinicians navigate through potential misdiagnoses. She emphasizes the importance of recognizing subtle indicators of the disease and thinking outside the box when it comes to the location of lesions, as they may present in atypical areas. She also highlights the significance of recurrent history, which can serve as a diagnostic hallmark.
Next, the pair discusses comorbidities associated with HS, with Dr Hsiao detailing the importance of inquiring about patients' primary care arrangements. She notes that while dermatologists may not directly manage these comorbidities, they can play a vital role in identifying and initiating the necessary steps toward management.
The discussion then moves to the significant psychological impact of HS, emphasizing the necessity of open dialogue with patients about the psychological toll of HS and the benefits of seeking mental health support. Screening tools like the PHQ-2 can aid in identifying patients at risk and initiating necessary interventions.
They next address the limitations of current clinical guidelines for HS and the need for a paradigm shift towards intervening earlier in the disease process to prevent irreversible tissue damage.
The discussion concludes with the presentation of a clinical scenario describing a patient transitioning from oral antibiotics to a biologic, with Dr Hsiao outlining her suggested approach for such a patient.

In this 2-part special edition of Derms and Conditions, host James Q Del Rosso, DO, sits down with David Light, cofounder and president of Valisure, and Christopher Bunick, associate professor of dermatology and translational medicine at Yale University and medical and dermatologic advisor for Valisure, to shed light on Valisure’s recent Citizen Petition to the US Food and Drug Administration regarding findings of high levels of benzene in benzoyl peroxide-containing products.
In Part 1, Dr Del Rosso interviews David Light, cofounder and president of Valisure, an independent quality assurance company that aims to address a critical gap in the health care supply chain. Dr Del Rosso and Mr Light delve into the details regarding how a product review gets initiated, the financial source of such reviews, and the important differences between Valisure’s work and that of Good Manufacturing Practice (GMP) testing facilities. Finally, they address the impact that manufacturing issues have on the increasing incidences of drug shortages in the United States.
In Part 2, Dr Del Rosso continues his conversation with David Light to discuss stability testing—what it is, why it’s important, and how Valisure undertook stability testing on products containing benzoyl peroxide. Mr Light details the rationale for conducting accelerated stability testing at elevated temperatures to evaluate the safety of the products across their entire lifecycles. Dr Bunick also joins the conversation to comment on the misperceptions about FDA-allowable limits of benzene in consumer products and the urgent need for change in how products are evaluated and formulated to ensure patient safety first and foremost. Lastly, Dr Del Rosso and Dr Bunick discuss how dermatologists should counsel patients in the short term on minimizing the risk of benzene exposure while we await further testing, external validation, and regulatory guidance.