Derms and Conditions

In this episode of Derms and Conditions, host James Q. Del Rosso, DO is joined by Stefan Weiss, MD for a focused discussion on compounding in dermatology, an area that often operates with less visibility but carries important clinical implications.

The conversation centers on the regulatory and practical differences between 503A and 503B compounding pharmacies, with particular attention to 503A facilities, where customized medications are prepared based on individual prescriptions. They outline key concerns with this model, including variability in formulation, lack of standardized testing, and limited oversight compared with FDA-approved therapies. Unlike commercially developed medications, compounded products are not required to undergo stability testing, penetration studies, or clinical trials, raising questions about consistency, efficacy, and safety.

A recurring theme is the challenge of knowing exactly what patients receive. Without controls on formulation integrity or bioavailability, clinicians may encounter variability not only between pharmacies, but even between batches from the same source, highlighting how this uncertainty can complicate treatment decisions.

The episode also contrasts compounded therapies with FDA-approved options, using topical clascoterone as an example of a rigorously tested, standardized formulation. While both speakers acknowledge that compounding has a role, particularly in addressing unmet or niche patient needs, they note that its use today has expanded beyond its original intent.

Tune in to the episode to hear how clinicians can approach compounded therapies with greater scrutiny, balance their use against standardized treatments, and make more informed decisions in everyday dermatology practice.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Heather Woolery-Lloyd, MD, for a treatment-focused discussion on acne management in an era where patient expectations, product awareness, and regimen complexity continue to rise.

 

The conversation opens with a shift many dermatologists are seeing in practice: patients arriving more informed and more influenced by social media, asking detailed questions about ingredients, formulations, and skin care routines. This evolving dynamic requires clinicians to not only select effective therapies but also contextualize an expanding array of over-the-counter and adjunctive options.

 

Dr Woolery-Lloyd and Dr Del Rosso revisit foundational therapies such as benzoyl peroxide, addressing concerns around benzene and reinforcing its continued role as a reliable, effective agent. They emphasize the importance of formulation and tolerability, noting that lower concentrations (around 4% or less) can offer similar efficacy with reduced irritation when well-formulated.

 

A central theme is the growing importance of the skin barrier and microbiome in acne management. The speakers highlight how barrier-supportive skin care, including moisturizers and adjunctive products, can improve both tolerability and clinical outcomes. They underscore that regimen success often depends on the full system of care, not just prescription therapies.

 

The discussion also explores newer over-the-counter formulations, including polyhydroxy acids for gentle exfoliation, multifunctional moisturizers targeting post-inflammatory hyperpigmentation, and emerging adjuncts like hypochlorous acid sprays (particularly useful for truncal acne).

 

Throughout, the episode reinforces a practical message: effective acne management today requires thoughtful integration of prescription therapies, formulation science, and patient-centered skin care guidance.

Tune in to the episode to hear how clinicians are navigating increasingly informed patients, optimizing tolerability without sacrificing efficacy, and building acne regimens that account for both therapeutic impact and real-world adherence.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Hilary Baldwin, MD, for a treatment-focused discussion on acne management, with particular attention to how newer topical therapies are reshaping treatment approaches.

They begin by reflecting on how patient expectations and therapeutic options have shifted over the past decade. Dr Baldwin highlights improvements in topical formulations that have enhanced both efficacy and tolerability, allowing many patients with mild to moderate and even some severe acne to be managed with topicals alone. This shift has also reduced reliance on prolonged oral antibiotic use.

They next address practical considerations, including access and adherence. Dr Baldwin discusses the role of specialty pharmacies in helping ensure patients receive prescribed therapies without substitution and the importance of providing specific skin care recommendations to minimize irritation and improve outcomes.

A key focus of the conversation is topical clascoterone, a first-in-class androgen receptor inhibitor that targets the androgen-sebum pathway and reduces sebum production progressively over time. They emphasize the benefit of initiating it early and setting appropriate expectations with patients, as its therapeutic effects build over 2 to 3+ months. Both clinicians advocate pairing clascoterone from the outset with a combination of topical agents that addresses other pathophysiologic cascades in acne to provide early visible improvement while supporting longer-term disease control. Other agents, such as benzoyl peroxide, topical retinoids, and clindamycin, are available in combination topical formulations to allow for ease of use, including a triple-combination topical gel.   

They also discuss strategies for simplifying complex regimens, especially for younger patients, and review admixture data supporting compatibility between clascoterone and other topical agents.

Tune in to the episode for practical pearls on designing combination topical regimens, setting realistic expectations with patients, and applying these strategies to optimize acne management.

Disclaimer: This podcast is not intended to provide diagnosis, treatment, or medical advice. Content provided in this podcast is for educational purposes only. Please consult with a physician regarding any health-related diagnosis or treatment.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Joseph Merola, MD, for a clinically focused discussion on updates in cutaneous lupus erythematosus (CLE). Long considered an area with limited therapeutic progress, CLE is gaining renewed attention as advances in disease biology and immunopathogenesis begin to inform new therapeutic approaches.

They begin by discussing the importance of early recognition, particularly for scarring forms such as discoid lupus erythematosus, where permanent damage often drives diagnosis rather than earlier inflammatory changes. To help clinicians recognize disease activity sooner, Dr Merola shares a practical mnemonic (PASTE) highlighting features including follicular plugging, atrophy, scarring, telangiectasia, and erythema.

They next discuss the clinical nuances of subacute cutaneous lupus erythematosus, including the need to evaluate for drug-induced disease. Medications such as hydrochlorothiazide and over-the-counter proton pump inhibitors may act as triggers and require careful medication history review.

They next review current and emerging treatment strategies. While first-line therapy remains centered on antimalarials such as hydroxychloroquine, attention is increasingly turning toward targeted therapies approved for other immune-mediated diseases. For example, anifrolumab, which inhibits type I interferon signaling and is approved for systemic lupus, has demonstrated activity in cutaneous lupus and is being evaluated in dedicated trials. Similarly, the TYK2 inhibitor deucravacitinib, approved for psoriasis and psoriatic arthritis, has shown signals of efficacy for lupus-associated skin disease in early studies.

They then discuss investigational therapies being developed specifically for lupus pathways. Among these is litifilimab, a monoclonal antibody targeting plasmacytoid dendritic cells to reduce type I interferon signaling. With fast-track designation and emerging clinical data, litifilimab highlights ongoing efforts to develop therapies directed at key immunologic drivers of both cutaneous and systemic lupus.

Tune in to the full episode to hear diagnostic pearls for recognizing CLE earlier, strategies for identifying drug-induced disease, and perspectives on emerging therapies under investigation for cutaneous lupus.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Michelle Tarbox, MD, for a candid discussion about the realities of leading a dermatology department and training the next generation of dermatologists.

Dr Tarbox reflects on the vision she brought to her role as department chair and the principles that guide her approach to residency education. Central to that philosophy is cultivating enthusiastic, lifelong learners. While a strong grounding in foundational dermatology, including historical therapies, is essential, she emphasizes that residents must also be fluent in emerging therapies and evolving evidence. She highlights the value of conferences, podcasts, and other modern educational resources that help clinicians remain current while connecting learning to real-world practice.

The conversation also explores the growing influence of artificial intelligence (AI) in medicine. Dr Tarbox notes that AI tools are becoming increasingly accessible and may support educational development and information gathering. However, she cautions that technology should complement, not replace, clinical judgment. Both clinicians agree that medical students and residents must learn to critically evaluate AI-generated content, verify references, and take responsibility for the work they sign their names to. She shares practical strategies for mentoring trainees in this area, including careful citation review and clear expectations around responsible AI use.

Finally, she reflects on the leadership lessons she has learned since becoming chair, including the importance of communication, collaborative decision-making, and balancing ambitious ideas with institutional realities.

Tune into the episode to hear Dr Tarbox share insights on dermatology leadership, residency education, responsible use of emerging technologies, and the behind-the-scenes decisions that shape the training of future dermatologists.