Derms and Conditions

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes E. James Song, MD, for a discussion of the IL-23 pathway and its enduring role in psoriasis management. Although therapeutic options continue to expand, IL-23 remains a central target because of its key role in the IL-23/Th17 axis, one of the primary drivers of psoriatic disease.

Dr Song reviews the current IL-23 therapeutic landscape, comparing available agents that target the pathway through different mechanisms. He highlights important distinctions among therapies, including dosing intervals, molecular characteristics, binding affinity, and immunogenicity, while emphasizing that all have demonstrated strong efficacy and favorable safety profiles. The conversation also explores how these pharmacologic differences do—and do not—translate into meaningful clinical differences.

The conversation also explores patient access, with Drs Del Rosso and Song discussing how route of administration and insurance coverage can significantly influence treatment selection, particularly for Medicare beneficiaries. They examine the practical advantages of health care provider-administered therapy, including more reliable treatment delivery, closer patient follow-up, and reduced financial barriers for some patients.

The discussion also addresses expectations for treatment response, emphasizing that IL-23 inhibitors may require more time than other biologic classes to achieve maximal benefit. Dr Song shares practical insights into assessing early improvement, counseling slower responders, and supporting long-term treatment persistence.

The episode concludes with a review of the safety profile of IL-23 inhibitors, including their role in psoriasis with peripheral psoriatic arthritis, while discussing areas where these therapies remain more limited, such as axial disease and uveitis.

Tune in to the full episode to learn more about the IL-23 pathway, the similarities and distinctions among available therapies, practical access considerations, and setting realistic expectations for treatment response in everyday psoriasis care.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Alexandra Golant, MD, for a discussion on the evolving role of topical therapies in atopic dermatitis (AD). While systemic therapies have transformed care for patients with moderate to severe disease, this discussion explores how topical treatments remain essential, not only for managing flares but also for maintaining long-term disease control.

Dr Golant reflects on how the topical treatment landscape has changed over the past several years. After decades in which topical corticosteroids remained the cornerstone of therapy, recent advances have introduced multiple nonsteroidal options with distinct mechanisms of action and improved suitability for chronic, proactive management.

The conversation explores where topical corticosteroids continue to fit in modern AD management. Rather than viewing steroids as obsolete, Dr Golant advocates for a balanced approach that considers efficacy, access, and appropriate stewardship. She emphasizes that corticosteroids remain valuable for short-term use but encourages clinicians to transition thoughtfully to nonsteroidal therapies when appropriate.

Dr Del Rosso and Dr Golant also review the expanding range of nonsteroidal topical therapies, including JAK inhibitors, PDE4 inhibitors, and the first-in-class aryl hydrocarbon receptor (AhR) agonist, tapinarof. Because AhR agonism represents an unfamiliar mechanism for many clinicians, Dr Golant explains how activation of this pathway not only reduces inflammatory signaling but also supports skin barrier function and antioxidant activity, helping address multiple aspects of AD pathophysiology.

The discussion also examines emerging clinical experience with tapinarof in AD, including its once-daily dosing, favorable safety profile, and potential to provide durable disease control in some patients. Dr Golant highlights the importance of challenging outdated assumptions that nonsteroidal therapies are slower or less effective than topical corticosteroids, noting that newer agents can achieve meaningful improvements in itch and skin clearance while providing flexibility for long-term management.

Tune in to the full episode to hear Drs Del Rosso and Golant discuss how they incorporate modern topical therapies into real-world AD management, where corticosteroids still have an important role, and why advances in nonsteroidal treatments are changing the way clinicians approach both acute flares and long-term disease control.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Walter Liszewski, MD, for a discussion on the role of patch testing in patients with atopic dermatitis (AD), from the fundamentals of testing and interpretation to its application in patients with persistent or incomplete responses to therapy.

Dr Liszewski explains why allergic contact dermatitis is frequently overlooked in dermatology practice and how it commonly overlaps with AD and irritant contact dermatitis. Because these conditions often appear clinically similar, Dr Liszewski explains that, unlike AD or irritant contact dermatitis, allergic contact dermatitis has a diagnostic test available, making patch testing an important tool when the underlying cause of eczema is uncertain.

The conversation explores when patch testing should be considered in light of the absence of formal guidelines, with Dr Liszewski sharing his practical approach to identifying patients who may benefit from testing and how it can fit into the management of patients who continue to experience residual eczema despite advanced therapies. He also discusses the different reasons biologic-treated patients may have persistent disease and how patch testing can help distinguish allergic contact dermatitis from a more complex inflammatory phenotype.

Dr Liszewski reviews practical considerations for preparing patients for patch testing, including which medications should be discontinued beforehand and which can generally be continued. He explains why he typically does not stop biologic therapy before testing, while outlining situations in which temporary interruption may be appropriate. The discussion also covers newer molecular testing that may provide additional information in difficult cases and introduces the "paraben paradox," an important concept illustrating how impaired skin barrier function can influence allergic responses.

Tune in to the episode to gain a clearer understanding of when patch testing should be considered in patients with AD, learn how to approach patients with persistent or partial treatment responses, and learn practical considerations for preparing patients and optimizing test accuracy.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, sits down with Melinda Gooderham, MD, for a wide-ranging conversation about the evolution of dermatology, clinical research, and the therapeutic advances that have transformed patient care over the course of her career.

Dr Gooderham reflects on how an early frustration with patient access to emerging biologic therapies led her into clinical research, a decision that not only expanded treatment opportunities for her patients but also shaped her professional focus on inflammatory skin diseases. She discusses how participating in clinical trials deepens understanding of both disease states and therapeutic mechanisms, often accelerating the development of clinical expertise.

The conversation explores some of the most dramatic changes she has witnessed in practice, particularly the impact of JAK inhibitors across multiple dermatologic conditions. Dr Gooderham shares observations from alopecia areata, granulomatous diseases, dermatomyositis, and bullous pemphigoid, highlighting instances where treatment responses exceeded expectations and significantly improved patients’ quality of life.

Dr Del Rosso and Dr Gooderham also discuss areas where therapeutic expectations have been more tempered, including in the role of oral PDE4 inhibitors in psoriasis, before turning to the future of dermatology. Topics include the emergence of highly effective oral therapies, the potential for extended-duration biologics, and how these advances may reshape treatment decision-making and patient preferences.

They conclude with an important discussion on the growing emphasis on early intervention. As treatment options continue to expand, the challenge is increasingly not whether a disease can be treated, but whether patients can be identified and managed early enough to prevent irreversible consequences and optimize long-term outcomes.

Tune in to the episode to hear Dr Gooderham's reflections on the therapies, discoveries, and clinical moments that have most influenced her career, along with her perspective on where dermatology may be headed next.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes back Michael Payette, MD, a dermatologist in private practice in Connecticut, for a wide-ranging discussion on the realities of managing hidradenitis suppurativa (HS) in clinical practice.

Drawing from his experience running a dedicated HS clinic, Dr Payette reflects on what surprised him most after launching the practice, including the number of early-stage referrals and the growing recognition that even patients with relatively mild disease may benefit from more proactive care. The conversation highlights the importance of identifying HS earlier in its course, before patients develop irreversible scarring, sinus tracts, and other long-term sequelae.

Drs Del Rosso and Payette discuss the logistical and emotional complexity of caring for patients with HS, emphasizing that meaningful visits cannot be compressed into a few minutes. Dr Payette shares how he structures conversations around realistic goal-setting, long-term therapeutic partnerships, and individualized treatment “buckets” ranging from topical and systemic therapies to lifestyle considerations, clinical trials, and surgery. The discussion also explores the psychological burden of HS, including how issues such as intimacy, work absenteeism, and social isolation often shape the patient experience as much as the physical disease itself.

They also examines evolving treatment strategies for HS, including the challenges of managing patients in the mild-to-moderate range, the rationale for early intervention, and the growing role of combination therapy. Dr Payette shares insights on combining biologic and JAK inhibitor therapies in select patients, integrating GLP-1 agents into treatment plans, and balancing medical and surgical management to optimize outcomes. Throughout the discussion, both physicians emphasize the importance of empathy, collaboration, and helping dermatologists feel more comfortable initiating treatment for HS, even if they ultimately refer more advanced cases to specialized colleagues.

Tune in to the episode to hear insights on building therapeutic relationships with patients with HS, approaching multifactorial disease management, recognizing opportunities for earlier intervention, and navigating the therapeutic landscape for this historically underserved disease state.