Dermatology Weekly

In the news:

Baseline body surface area may drive optimal baricitinib responses

Avoiding atopic dermatitis triggers easier said than done

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Psoriasis patients often have additional comorbidities that put them at higher risk for developing COVID-19. In this episode, Candrice R. Heath, MD (@DrCandriceHeath), talks to Mark G. Lebwohl, MD, about the benefits of continuing biologic therapies for psoriasis during the COVID-19 pandemic. They discuss findings from registry data in Italy and New York City and how the data have impacted the latest guidelines for treatment. “The [National Psoriasis Foundation COVID-19 Task Force] has come out with a recommendation that strongly encourages patients on biologics to take [the COVID-19] vaccination and to not interrupt your biologic therapy,” Dr. Lebwohl explains. They also discuss how dermatologists can counsel patients about the safety of biologics so they feel comfortable continuing treatment during the pandemic.

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Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia)

Guests: Mark G. Lebwohl, MD (Icahn School of Medicine at Mount Sinai, New York)

Disclosures: Dr. Heath reports no conflict of interest. Dr. Lebwohl is an employee of Mount Sinai and has received research funds and consulted with numerous pharmaceutical companies.

Show notes by: Alicia Sonners, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts     

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm

Dermatology News:

Swedish registry study finds atopic dermatitis significantly associated with autoimmune diseases

Guidance issued on COVID vaccine use in patients with dermal fillers         

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Dermatologic adverse events can present differently in patients with skin of color (SOC) than in White patients. In this episode, Candrice R. Heath, MD (@DrCandriceHeath), talks to Sarah J. Noor, MD, and medical student Dulce Barrios about how skin toxicities from systemic cancer therapies and radiation treatment manifest in SOC patients, particularly in the form of pigmentary changes. “We really need to understand the pathogenesis or etiology of this discoloration, because I think when this is the initial presenting feature, it’s possible … even though it looks more just like hyperpigmentation on the skin, that there is some underlying inflammatory process going on,” Dr. Noor explains. They also discuss barriers that limit participation of SOC patients in oncology clinical trials.

Dr. Noor and Ms. Barrios’s poster from the Skin of Color Society (@SkinOfColor) Scientific Symposium won the Best Oral Presentation Advancing Skin of Color Dermatology “Facing the Future Award.”

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Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia)

Guests: Sarah J. Noor, MD (Memorial Sloan Kettering Cancer Center, New York); Dulce Barrios, MS (State University of New York, Syracuse)

Disclosures: Dr. Heath reports no conflict of interest. Dr. Noor participated in an advisory board for Kyowa Kirin. Ms. Barrios reports no conflict of interest.

Show notes by: Allegra Sparta, Alicia Sonners

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm

This year's top peer-to-peer interviews focus on diversity in residency training, the response to COVID-19 in academic dermatology, and tips for preparing for virtual residency interviews. 

1. Diversity in residency training 

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Dermatology News:

1. Beware a pair of dermatologic emergencies in children: https://bit.ly/37mGA2d
2. Preadolescent acne: Management from birth requires increasing vigilance: https://bit.ly/34mCWn0

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Managing vitiligo can be difficult for both patients and physicians. In this episode, guest host Seemal R. Desai, MD, (@SeemalRDesaiMD) talks to Pearl E. Grimes, MD, about how to better classify vitiligo disease status and parameters that impact treatment choice. “There are some aspects of classification that are really key from a therapeutic as well as a prognostic perspective. The things that I look at on a day-to-day basis when I workup any new patient [include asking], what type of vitiligo do you have? Is it nonsegmental or is it segmental? Is the patient stable or are they progressive? And then I look at the severity of disease,” Dr. Grimes explains. They discuss the importance of stabilizing vitiligo, particularly on the face, and highlight the psychosocial impact of the disease. Dr. Grimes also highlights the role of supplements and antioxidants such as vitamin D in vitiligo treatment.

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Hosts: Seemal R. Desai, MD (Innovative Dermatology, Dallas, and the University of Texas Southwestern Medical Center, Dallas)

Guests: Pearl E. Grimes, MD (Vitiligo & Pigmentation Institute of Southern California, Los Angeles)

Disclosures: Dr. Desai reports no conflict of interest. Dr. Grimes has conducted clinical research and/or served as a consultant for Clinuvel Pharmaceuticals, Dermaforce, Johnson & Johnson, Incyte, LaserOptek, L’Oréal, Pfizer, Procter & Gamble, and VT Technologies.

Show notes by: Alicia Sonners, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm

Dermatology News:

1. International expert group agrees on redefining psoriasis severity
   https://bit.ly/3a6a7PJ
2. ‘Impressive’ results with neoadjuvant T-VEC in advanced melanoma: https://bit.ly/39UEwA3
3. CDC shortens COVID-19 quarantine time to 10 or 7 days, with conditions: https://bit.ly/3qGIGSn

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Procedural interventions in pediatric patients require special tools. Vincent A. DeLeo, MD, talks to Craig N. Burkhart, MD, MS, MPH, about dermatologic procedures in children, such as laser treatment of birthmarks or excisional mole removal. When considering general anesthesia use in children, Dr. Burkhart reflects that, “if [the patient is] a child that sits for a vaccination without a problem, they’re definitely ready to have minor surgery awake. If ... you have to pull them out from behind the bed, they’re definitely a child that is not ready.” They also discuss the importance of informed consent in teenaged patients.

Article: https://www.mdedge.com/dermatology/article/231231/pediatrics/pediatric-procedural-dermatology

Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT106005253.PDF

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Hosts: Nick Andrews, Vincent A. DeLeo, MD (University of Southern California, Los Angeles)

Guest: Craig N. Burkhart, MD, MS, MPH (department of dermatology, University of North Carolina at Chapel Hill, and Burkhart Pediatric & Adolescent Dermatology, Cary, N.C.)

Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Burkhart reports no conflict of interest.

Show notes by: Allegra Sparta, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Dermatology News:

1. International expert group agrees on redefining psoriasis severity
   https://bit.ly/3a6a7PJ
2. ‘Impressive’ results with neoadjuvant T-VEC in advanced melanoma: https://bit.ly/39UEwA3
3. CDC shortens COVID-19 quarantine time to 10 or 7 days, with conditions: https://bit.ly/3qGIGSn

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Procedural interventions in pediatric patients require special tools. Vincent A. DeLeo, MD, talks to Craig N. Burkhart, MD, MS, MPH, about dermatologic procedures in children, such as laser treatment of birthmarks or excisional mole removal. When considering general anesthesia use in children, Dr. Burkhart reflects that, “if [the patient is] a child that sits for a vaccination without a problem, they’re definitely ready to have minor surgery awake. If ... you have to pull them out from behind the bed, they’re definitely a child that is not ready.” They also discuss the importance of informed consent in teenaged patients.

Article: https://www.mdedge.com/dermatology/article/231231/pediatrics/pediatric-procedural-dermatology

Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT106005253.PDF

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Hosts: Nick Andrews, Vincent A. DeLeo, MD (University of Southern California, Los Angeles)

Guest: Craig N. Burkhart, MD, MS, MPH (department of dermatology, University of North Carolina at Chapel Hill, and Burkhart Pediatric & Adolescent Dermatology, Cary, N.C.)

Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Burkhart reports no conflict of interest.

Show notes by: Allegra Sparta, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Dermatology News:

1. Expanded indications likely for apremilast: https://bit.ly/3lx1zTZ
2. Neoadjuvant immunotherapy combo produces high response rate in melanoma: https://bit.ly/33Dx0Wr
3. Blood glucose on admission predicts COVID-19 severity in all: https://bit.ly/39yJjXS

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Advances in noninvasive skin imaging present new opportunities for inclusion and equitable treatment of patients with skin of color. In this episode, Candrice R. Heath, MD (@DrCandriceHeath), talks to Josèe Smith and Steven Daveluy, MD, about the use of optical coherence tomography (OCT) to establish a baseline for all skin types can improve how dermatologists process pathology in the skin. They review various factors that influence OCT results and how results differ based on Fitzpatrick skin type, age, and level of sun exposure. They also highlight the benefits of noninvasive imaging versus biopsy in clinical practice. “[Even] though skin cancer is less common in skin of color, we know that melanoma and other types of skin cancer are usually diagnosed at later stages and more complicated stages, and so having earlier ways of detecting skin cancer in skin of color I think is really important for the future,” Ms. Smith explains.

Ms. Smith and Dr. Daveluy’s poster from the Skin of Color Society (@SkinOfColor) Scientific Symposium won the Crowd Favorite award.

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Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia, Pennsylvania)

Guests: Josèe Smith, BS (Wayne State University, Detroit); Steven Daveluy, MD (Wayne State University and Wayne County Medical Society of Southeast Michigan, Detroit)

Disclosures: Dr. Heath, Ms. Smith, and Dr. Daveluy report no conflicts of interest.

Show notes by: Alicia Sonners, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts     

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm

Dermatology News:

1. Merino wool clothing improves atopic dermatitis, studies find: https://bit.ly/3fFHQQI
2. Tildrakizumab for psoriasis shows durable efficacy over 5 years: https://bit.ly/3l1Z0c9
3. AMA takes on vaccine misinformation, physician vaccines, racism: https://bit.ly/33ee0O2

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Nail unit squamous cell carcinoma (SCC) is difficult to diagnose or suspect clinically because of its tendency to present as nonspecific nail plate changes. The tumors usually are painless and asymptomatic, leading to a delay in diagnosis. In this resident takeover, Daniel R. Mazori, MD, talks to Mohammed Dany, MD, PhD, about nail unit SCC and the importance of early diagnosis to avoid local destruction and bone invasion. “Usually, any subungual lesion in an immunosuppressed individual, especially if it is chronic and nonhealing, would prompt a biopsy,” Dr. Dany explains. They also discuss other risk factors and potential causes for nail unit SCC, with a particular focus on human papillomavirus infection, as well as treatment options including surgery.

Article: https://www.mdedge.com/dermatology/article/231900/hair-nails/nail-unit-squamous-cell-carcinoma-updates-diagnosis-surgical?channel=64

Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT106005011_e.PDF

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Hosts: Nick Andrews; Daniel R. Mazori, MD (State University of New York, Brooklyn)

Guests: Mohammed Dany, MD, PhD (Department of Dermatology, University of Pennsylvania, Philadelphia)

Disclosures: Dr. Mazori and Dr. Dany report no conflict of interest.

Show notes by: Allegra Sparta, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm

Dermatology News:

1. Low threshold to biopsy atypical lesions may ID vulvar melanoma early, experts say https://www.mdedge.com/dermatology/article/231855/gynecologic-cancer/low-threshold-biopsy-atypical-lesions-may-id-vulvar
   
   
2. Chronic inflammatory diseases vary widely in CHD risk https://www.mdedge.com/dermatology/article/231815/cad-atherosclerosis/chronic-inflammatory-diseases-vary-widely-chd-risk
   
   
3. ‘Hospital at home’ increases COVID capacity in large study https://www.mdedge.com/dermatology/article/232113/coronavirus-updates/hospital-home-increases-covid-capacity-large-study

The COVID-19 pandemic has brought many longstanding health disparities to the forefront, particularly within the field of dermatology. In this episode, Candrice R. Heath, MD (@DrCandriceHeath) talks to Susan C. Taylor, MD, and Lynn McKinley-Grant, MD, about the impact dermatologists can have in reducing health care barriers among skin of color populations. They emphasize the importance of race-concordant visits and reflect on ways to foster diversity, equity, and inclusion in the dermatology workforce, beginning at the training and residency levels. “[We know] that minority dermatologists serve in underserved communities, that they accept public insurance or no insurance at all. They care for patients with particularly poor health status and are really committed to caring for patients of their own race. So it behooves all of us to examine ... how we can make a change and increase racial ethnic diversity within the specialty of dermatology,” Dr. Taylor explains. They also highlight how organizations such as the American Academy of Dermatology and the Skin of Color Society, among others, are working to institute meaningful change within the specialty.

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Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia)

Guests: Susan C. Taylor, MD (University of Pennsylvania, Philadelphia); Lynn McKinley-Grant, MD (Howard University, Washington)

Disclosures: Dr. Heath reports no conflict of interest. Dr. Taylor is vice president of the AAD. Dr. McKinley-Grant is president of the Skin of Color Society.

Show notes by: Alicia Sonners, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts     

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm

Dermatology News:

1. Who’s at risk for depression on isotretinoin?: https://bit.ly/32AioXp
2. Topical tapinarof effective in pivotal psoriasis trials: https://bit.ly/3pma0o0
3. Methotrexate users need tuberculosis tests in high-TB areas: https://bit.ly/3f0DcMV

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Keeping up with the literature on atopic dermatitis (AD) is a challenge, with eight new articles posted on PubMed a day in 2020. Vincent A. DeLeo, MD, talks to Lawrence F. Eichenfield, MD, about quality of life in pediatric AD patients and how the condition affects parents/guardians, particularly in the form of sleep disturbances. Dr. Eichenfield also discusses studies that explore the impact of bathing frequency on the severity of AD as well as notable treatment advances in topical and systemic therapies in recent years. Reflecting on future research, Dr. Eichenfield posited if “recognizing significant disease early and instituting our more aggressive therapies early, will that change the development of comorbidities and will that burn out the disease more quickly or get sustained remission or cure as compared to just waiting?”

Article: https://bit.ly/3f0DrHP

Downloadable PDF: https://bit.ly/3lzuUy1

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Hosts: Nick Andrews, Vincent A. DeLeo, MD (University of Southern California, Los Angeles)

Guest: Lawrence F. Eichenfield, MD (division of pediatric dermatology, departments of dermatology and pediatrics, University of California, San Diego, and Rady Children’s Hospital, San Diego)

Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Eichenfield is an investigator for AbbVie, LEO Pharma, Pfizer, Regeneron, and Sanofi Genzyme. He also is a consultant for Almirall, Dermavant Sciences, Dermira, DS Biopharma, Eli Lilly, Forte Biopharma; Galderma Laboratories, Incyte, LEO Pharma, Novartis, Ortho Dermatologics, Otsuka Pharmaceutical, Pfizer, Regeneron Pharmaceuticals, and Sanofi Genzyme.

Show notes by: Allegra Sparta, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]