Dermatology Weekly

Episode 79, the top resident takeovers of 2020 (so far).

We count down the top downloaded resident interviews of Dermatology Weekly in 2020. So far this year, a variety of topics affecting residents have been covered—from the impact of training during COVID-19 to the use of low-dose naltrexone to over-the-counter (OTC) topicals in dermatology and Muir-Torre syndrome.

Dermatology residency during a pandemic, Episode 73: Dr. Candrice Heath talked to three dermatology residents—Dr. Brittany Oliver (on Instagram: @dr.dermatic), Dr. Sophie Greenberg (@sophiegreenberg), and Dr. Julie Croley (@DrSkinandSmiles)—about their experiences navigating through dermatology residency during the COVID-19 pandemic. They shared their perspectives from different areas of the country on how the current health crisis has impacted their training and responsibilities.

Low-dose naltrexone, Episode 52: Dr. Daniel Mazori talked to Dr. Nadine Shabeeb about the benefits of off-label low-dose naltrexone (LDN) for the treatment of inflammatory skin conditions. Dr. Shabeeb provided a practical perspective on prescribing LDN in the dermatology setting and discussed how to counsel patients about potential side effects, including concerns about its abuse potential.

OTC topicals, Episode 65: Dr. Daniel Mazori talked to Dr. Sophie Greenberg about selection of OTC topicals to avoid potential adverse effects. They discussed how the Food and Drug Administration categorizes and regulates OTC products as well as resources to learn more about common ingredients in OTC topicals.

Muir-Torre syndrome (MTS), Episode 61: Dr. Daniel Mazori talked to Dr. Mohammed Dany about the pathogenesis of MTS and its associated malignancies. They also reviewed diagnostic clues and tools for dermatologists when treating patients with solitary sebaceous tumors.

Host: Nick Andrews

Dr. Croley, Dr. Dany, Dr. Greenberg, Dr. Heath, Dr. Mazori, Dr. Oliver, and Dr. Shabeeb report no conflicts of interest.

Show notes by: Melissa Sears, Alicia Sonners

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 is an academically rigorous specialty, which is a major source of stress for many residents. Daniel Mazori, MD, talks to Nadine Shabeeb, MD, MPH about dermatology resident wellness and burnout.

They discuss stressors for burnout in dermatology residents. “I do think that on a day-to-day basis the major stressor for me in residency is probably related to the amount of studying that we need to do,” Dr. Shabeeb reports. They also provide strategies for improving resident wellness by addressing the four areas of well-being.

Article: https://bit.ly/2FMEGNf

Downloadable PDF: https://bit.ly/2QaXkAj

This week in dermatology news:

1. Novel oral drug improves sunlight tolerance in patients with erythropoietic protoporphyra: https://bit.ly/34AeUWM
2. Large study finds no link between TCI use, skin cancer in patients with AD:  https://bit.ly/3locNuS
3. Hong Kong man gets COVID-19 twice: https://bit.ly/3hvMzEt

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

Guests: Nadine Shabeeb, MD, MPH (University of Wisconsin Hospital and Clinics, Madison)

Disclosures: Dr. Mazori and Dr. Shabeeb report no conflict 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

This week in Dermatology News:

1. Persistent hair loss after radiation improved with minoxidil: https://bit.ly/2FFY1zx
2. Telemedicine checklist may smooth visits with older patients: https://bit.ly/3aLVsav
3. FDA authorizes COVID-19 saliva test: https://bit.ly/34g7pUw

Dermatologists write more antibiotic prescriptions per individual clinician than other physicians, mostly to treat acne and rosacea. Dr. Vincent DeLeo talks to Dr. James Del Rosso about antibiotic use in dermatology. “Antibiotics are part of our armamentarium; they’re very important. … Primarily we’re using [antibiotics] for these inflammatory dermatoses that are not infections, and we’re prescribing them for a longer period of time,” Dr. Del Rosso explains. Dr. Del Rosso outlines acne therapies commonly associated with resistance and discusses when to use antibiotics for acne.

Article: https://bit.ly/2Eb7Hl9

Downloadable PDF: https://bit.ly/2Yg4ibw

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

Guest: James Q. Del Rosso, DO (JDR Dermatology Research/Thomas Dermatology, Las Vegas and Henderson, Nev.)

Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Del Rosso has served as an advisor, consultant, and speaker for Almirall, Bausch Health (Ortho Dermatologics), EPI Health, Foamix (Menlo Therapeutics), Galderma Laboratories, and Mayne Pharma. He also has served as a research investigator for Almirall, Bausch Health (Ortho Dermatologics), Foamix (Menlo Therapeutics), and Galderma Laboratories.

Show notes: 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

COVID-19 has had profound effects on the financial stability of academic institutions, resident training, and patient care. Candrice Heath, MD (@DrCandriceHeath) talks to Erin Boh, MD, and Dirk Elston, MD, about emergency response plans in the academic setting as well as how institutions have been using teledermatology and managing resident education.

“Our institution is doing quite well because we’ve actually jumped headlong and feetfirst into COVID research. . . . Our research dollars have increased double percentwise because of that," Dr. Boh said.

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This week in dermatology news:

1. Cutaneous clues linked to COVID-19 coagulation risk: https://bit.ly/31Ik4Ne
   Research letter: https://bit.ly/3kCnWIn
   Skin manifestations of COVID-19: https://bit.ly/2XUonnL
2. Study highlights potential advantages of tape strips over biopsy: https://bit.ly/33TTZxi
   Original source: https://bit.ly/30R4WOm
3. Botulinum toxin associated with antidepressant effects across indications, injection sites: https://bit.ly/2XVMd2m
   Original source: https://go.nature.com/3kGM38y

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

Guests: Erin Boh, MD, PhD (Tulane University, New Orleans); Dirk M. Elston, MD (Medical University of South Carolina, Charleston)

Disclosures: Dr. Heath, Dr. Boh, and Dr. Elston 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

Military dermatologists play a unique role in managing acne because they need to consider the medical readiness of servicemembers during treatment. Dr. Justin Bandino, president of the Association of Military Dermatologists, talks to Dr. Catherine Brahe and Dr. Kristopher Peters about avoiding antibiotics or systemic drugs that can limit a servicemember’s operational duty status, which can be applied to civilian health care to help slow the spread of antibiotic resistance. They highlight uses of pulsed-dye laser therapy. “I would hope that many of us in the military setting could take advantage of our ability to use this variety of lasers and treatment modalities so we can contribute to the literature and make them a little more mainstream, and then maybe in the future some of them can be covered by insurance and can be used a little more frequently,” Dr. Peters explains.

Article: https://bit.ly/31gQ62G
Downloadable PDF: https://bit.ly/39WcZwp

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This week in dermatology news:

1. New psoriasis guidelines focus on topical and alternative treatments, and severity measures: https://bit.ly/2DlBwyYJournal Article: https://bit.ly/39YsvYs
2. Medical Student in the UK creates handbook of clinical signs on darker skin: https://bit.ly/31lBqPJ
3. Biologics may delay psoriatic arthritis: https://bit.ly/2XxrEJc

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Hosts: Nick Andrews, Justin P. Bandino, MD (San Antonio Uniformed Services Health Education Consortium, Tex.)

Guests: Catherine Brahe, MD (Naval Medical Center, Portsmouth, Va., and 3rd Battalion 6th Marines, Camp Lejeune, N.C.); Kristopher Peters, DO (Madigan Army Medical Center, Tacoma, Wash.)

Disclosures: Dr. Bandino, Dr. Brahe, and Dr. Peters report no conflict 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

Unlike most other cutaneous neoplasms, extramammary Paget disease (EMPD) manifests as a chronic erythematous patch. In this resident takeover, Dr. Daniel Mazori talks to Dr. Mohammed Dany about the diagnosis of primary vs secondary EMPD and the importance of screening patients for metastasis or other underlying malignancies. They also discuss the pathogenesis of EMPD and highlight future treatment targets. “The best studies that show potential are the studies focusing on PD-1 [programmed cell death receptor 1] pathway, or the checkpoint pathway. I think there is a lot of potential with immunotherapy for EMPD,” Dr. Dany explains.

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This week in dermatology news:
* Americans getting more sunburns (https://bit.ly/33iNOD1)
* Nine states have no board-certified pediatric dermatologist, analysis reveals (https://bit.ly/3faY5Do) 
* Is the presence of enanthem a clue for COVID-19? (https://bit.ly/39F2bSV) 
(JAMA Research Letter: https://bit.ly/3hNZnpK)

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Things you will learn in this episode:

* Extramammary Paget disease characteristically presents as an erythematous patch in sites with abundant apocrine glands, such as the vulvar, scrotal, or perianal skin. “Usually the typical story would be, this is a rash that has been treated as eczema for many years but it just doesn’t go away, and it is only until the dermatologist gets a biopsy that the diagnosis of [EMPD] is made,” Dr. Dany explains.

* Classic biopsy findings include pagetoid spread through the epidermis with larger cells that have blue cytoplasm, dysmorphia, and nuclear atypia. It may appear similar to other pagetoid entities such as melanoma, intraepidermal sebaceous carcinoma, or squamous cell carcinoma in situ.

* Primary and secondary EMPD present in clinically and prognostically different ways, but it is difficult to discern the 2 entities based on histology.

* Extramammary Paget disease requires long-term follow-up to monitor for disease recurrence or further development of malignancies. “Every patient newly diagnosed with EMPD deserves a full workup for malignancy screening,” Dr. Dany explains.

* There currently is no formal staging system or treatment guidelines for EMPD. “Wide local excision has been the default in the past, but recurrence rates were very high,” Dr. Dany notes.

* More research is needed to understand the pathogenesis of EMPD, but data have shown that the PD-1/PD-L1 pathway may play an important role in future therapies.

* Intralesional immunotherapies can be effective in treating EMPD in sensitive areas of the body.

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Hosts: Nick Andrews; Daniel R. Mazori, MD (Brigham and Women’s Hospital, Boston)

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

Disclosures: Dr. Mazori reports no conflict of interest. Dr. Dany reports no conflict of interest.

Show notes: 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

To celebrate the 50th anniversary of Dermatology News, we are looking back at how the field has changed since that first issue in January 1970. The focus in episode 73 is infectious disease. There’s a lot to be grateful for but there are also challenges like antibiotic resistance that weren’t on the radar of dermatologists decades ago.

In this episode, Nick Andrews welcomes Theodore Rosen, MD, to discuss the past, future, and current state of ID Dermatology.

You can read more about the past 50 years of ID by clicking this link: https://bit.ly/3hri3v2
You can learn more about Dr. Rosen by clicking this link: https://bit.ly/2CtdmSU

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What will your dermatology residency look like in the midst of coronavirus disease 2019 (COVID-19)? In this episode, guest host Dr. Candrice Heath talks to Drs. Brittany Oliver (@dr.dermatic), Sophie Greenberg (@sophiegreenbergmd), and Julie Croley (@DrSkinandSmiles) about their experiences navigating through dermatology residency during the COVID-19 pandemic. They share their perspectives from different areas of the country on how the current health crisis has impacted their training and responsibilities. They also provide tips for incoming dermatology residents on how to adapt their expectations to the post-COVID environment.

“It was so rewarding and I was really anxious to get in and help, hearing about all the stories about exhausted physicians and patients who needed care, so I really felt called to be in the center of it and I’m really happy I could give back in that way,” Dr. Greenberg said of working with COVID-19 patients in New York City.

Key takeaways from this episode:

• Drs. Oliver, Greenberg, and Croley describe how their roles and duties as dermatology residents have changed as their institutions have prepared for surges of COVID-19 patients.
• They discuss the impact of the lockdown and shifting priorities within their hospitals on their learning structure and educational opportunities, including lectures and dermatopathology training. “Our didactics were converted to Zoom once the lockdown began. . . . Some attendings volunteered to give us extra lectures because our clinics were not operating in the normal way. It helped compensate to make sure we’re getting enough education and training,” Dr. Greenberg says.
• Teledermatology services have been crucial to continuing patient care during the pandemic. Drs. Oliver, Greenberg, and Croley talk about the challenges and benefits of using telemedicine both now and in the future. “I am glad to be getting the exposure now so that I can use the experience on a few different platforms, and then wherever I land for my first job, I can hopefully adapt quickly to whatever it is they’re using,” Dr. Oliver says.
• They offer advice for new dermatology residents who are coming into a residency experience that looks different now than what they expected because of COVID-19. “Everything’s changing on a day-to-day basis: the COVID situation’s changing, the rules and policies are changing in our hospital, what was protocol yesterday might not be protocol today. . . . I think just having patience, being adaptable, and just realizing that hey, everybody is going through the exact same thing . . . is really the best advice I would have for people,” Dr. Croley emphasizes.
• They reflect on medical knowledge and skills they otherwise would not have learned without their experience as dermatology residents during the COVID-19 pandemic.
• Residency typically is a time to get to bond with co-residents and lean on family and friends for support through stressful times. Drs. Oliver, Greenberg, and Croley discuss ways they have been staying connected with people during the lockdown and while social distancing.

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

Guests: Brittany Oliver, MD (Hospital of the University of Pennsylvania, Philadelphia); Sophie A. Greenberg, MD (Columbia University Medical Center, New York, NY); Julie Ann Amthor Croley, MD (The University of Texas Medical Branch at Galveston)

Disclosures: Drs. Heath, Oliver, Greenberg, and Croley report no conflicts of interest.

Show notes: 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 residents must be knowledgeable about dermatologic conditions presenting in patients of various ethnic backgrounds. Dr. Vincent DeLeo talks to Drs. Abigail Cline, Susan Taylor, and Amy McMichael about improving and expanding multiethnic training in dermatology residency. “Now that I’m in residency, it has become very clear how different presentations in skin of color can be, and I can really see the importance of proper training in a racially diverse population,” says Dr. Cline. They discuss ways to ensure that dermatology trainees get adequate exposure to conditions affecting ethnic skin and highlight the role of the Skin of Color Society in reducing racial disparities within the specialty.

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This week in Dermatology News:

1. Topical PDE-4 inhibitor for psoriasis effective in phase 2b trial

• Original story: https://bit.ly/38YtdV3

2. Subcutaneous nemolizumab eases itching for atopic dermatitis

• Original story: https://bit.ly/3j3U3jp
• NEJM article: https://bit.ly/32icCdG

3. About 1/3 of older Americans receive shingles vaccine

• Original story: https://bit.ly/2Cyz9rY
• CDC report: https://bit.ly/2WmhOJK 

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Key takeaways from this episode:

• There is a lack of minority representation in dermatology educational materials such as textbook photographs, which often are heavily skewed toward lighter skin types.
• Results from a recent survey revealed that dermatology residents in the Midwest and Northwest were not seeing a diverse patient population: “[Residents] in the Northeast, Southeast, and Southwest tended to see more diverse patients, and so they didn’t feel the need for continued lectures or skin of color clinics, but the respondents within the Midwest and the Northwest really wanted to see these patients and really wanted to see what these dermatoses look like in skin of color,” Dr. Cline explains. 
• To ensure dermatology trainees get adequate exposure to diverse populations, home programs can allow residents to travel and rotate to other programs where they can get firsthand experience diagnosing skin of color patients.
• The Skin of Color Society aims to reduce racial disparities in dermatology through a variety of programs, including its annual scientific symposium, mentorship program, and research grants.
• Skin of color centers throughout the United States allow dermatology residents to rotate through and work with large numbers of skin of color patients. “[They also provide] an opportunity for trainees to see patients who are very satisfied with race-concordant visits—that is, the patient and the provider are of the same racial group—so they can observe what goes into making that type of interaction very successful and rewarding for the patient,” says Dr. Taylor.
• Practicing dermatologists can make a positive impact by mentoring high school, college, or medical students who do not have social capital as well as contributing a gift to societies with mentorship programs that provide opportunities for residents.
• Dermatologists can create diversity within their own practices to improve patient access to care. “You can be great at what you do, you can be a fantastic dermatologist but still not be culturally competent, so looking at what that really means—how to understand populations that are different from you culturally, how to look at perhaps having individuals in your practice that can make those patients more comfortable . . . whether they may be your nurses or your intake people . . . just sort of looking around and seeing how you can diversify your own space so that when others come they feel like you know what you’re talking about, and I think that’s really the goal overall,” explains Dr. McMichael.   

Hosts: Nick Andrews; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles)

Guests: Abigail Cline, MD, PhD (New York Medical Center, New York, and Wake Forest School of Medicine, Winston-Salem, North Carolina); Susan C. Taylor, MD (University of Pennsylvania Perelman School of Medicine, Philadelphia); Amy J. McMichael, MD (Wake Forest Baptist Medical Center, Winston-Salem, North Carolina) 

Disclosures: Dr. DeLeo is a consultant for Esteé Lauder. Drs. Cline, Taylor, and McMichael report no conflict 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

Nutrient deficiencies present clinically in the skin, hair, and nails. Dr. Vincent DeLeo talks to Dr. Bridget Shields about the dermatologist’s role in managing nutritional dermatoses in hospitalized patients. “As dermatologists, we’re trained to recognize subtle detail, and we may be the first or really the only physicians to pick up on the seemingly minor cutaneous manifestations of underlying nutritional disease,” Dr. Shields explains. She highlights key nutrient deficiencies and risk factors that dermatologists may routinely encounter.

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This week in Dermatology News:

1. Lifestyle changes may explain skin lesions in pandemic era patients
2. Study highlights benefits of integrating dermatology into oncology centers
3. Republican or Democrat, Americans vote for face masks

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Key takeaways from this episode:

• Undernutrition in hospitalized patients is relatively common but often goes unrecognized because it may develop slowly over months to years. “Early identification and treatment of nutritional deficiencies can drastically improve patient morbidity and mortality and decrease systemwide health care costs,” Dr. Shields explains.
• It can be easier for dermatologists to diagnose and screen for nutrient deficiencies if they are able to identify at-risk patients. “Some really common medical conditions serve as risk factors that I think we routinely overlook as providers,” Dr. Shields notes.
• Dietary habits can predispose patients to nutrient deficiencies and therefore should be included as part of the patient’s history.
• The oral mucosa can provide important insight into a patient’s underlying metabolic and overall systemic health.
• Hospitalized patients often take in less calorically than they do at baseline. “I think working with a nutritionist can be really important to ensure a patient has appropriate macro- and micronutrient composition of any supplementation provided,” notes Dr. Shields.
• In most cases, treating the underlying nutrient deficiency will simultaneously treat the associated cutaneous manifestations.
• Skin-directed topical therapies can be useful in the right context but should not be used alone without the associated nutrient supplementation.
• More research is needed on how nutritional manipulation may impact the skin and serve as an adjunct to therapy with more traditional medication regimens.

Hosts: Nick Andrews; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles)

Guest: Bridget E. Shields, MD (University of Pennsylvania Perelman School of Medicine, Philadelphia)

Disclosures: Dr. DeLeo is a consultant for Esteé Lauder. Dr. Shields reports no conflict 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

This week in Dermatology News: 

1. Skin patterns of COVID-19 vary widely
   
   
2. First validated classification criteria for discord lupus erythematosus unveiled
   
   
3. Phase 3 COVID-19 vaccine trials launching in July

Dr. Vincent DeLeo counts down the top downloaded peer-to-peer interviews of Dermatology Weekly in 2020. So far this year, Dr. DeLeo and his colleagues have covered a diverse group of topics impacting the way dermatologists practice medicine, particularly during the COVID-19 pandemic—from the continued use of biologics in psoriasis patients to adopting teledermatology to recommending hair products for African American women.

Teledermatology, Episode 63: Dr. Candrice Heath talked to Dr. George Han about how dermatologists can adapt their clinical practice to conduct quality teledermatology visits with their patients. They discussed potential use cases for teledermatology during the current health crisis and beyond as well as how to address technological barriers to care.

Hair care products for African American women, Episode 60: Hair salon closures during the coronavirus pandemic have left women of African descent to care for their own hair at home. Dr. Lynn McKinley-Grant and Dr. Susan Taylor talked about hair care products these patients can use so that dermatologists can help African American women take care of their hair and manage dermatologic conditions.

Biologics during the COVID-19 pandemic, Episode 57: Patients with severe psoriasis may be at higher risk for infection because of increased inflammation in the body. Dr. Lawrence Green discussed how to counsel patients who are taking biologics to control their psoriasis during the COVID-19 pandemic.

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

Disclosures: Dr. DeLeo is a consultant for Estée Lauder.

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