Derms and Conditions

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.

In this episode of Tea with Dr. D, host James Q. Del Rosso delivers a solo “Spilling the Tea” segment that revisits oral isotretinoin through a longitudinal lens, connecting its early clinical foundations to present-day practice.

Framing isotretinoin as a “winding road,” Dr Del Rosso reflects on its 1982 approval, early safety observations, and the evolution of risk management strategies, including the iPLEDGE program. While concerns around psychiatric effects, inflammatory bowel disease, and teratogenicity have shaped prescribing behaviors, he emphasizes that most patients tolerate therapy well when appropriately monitored.

A central theme is the value of foundational knowledge. Dr Del Rosso highlights considerations that remain highly relevant, including dosing flexibility, relapse patterns, treatment duration, and importantly, the impact of absorption on outcomes. Conventional formulations require adequate dietary fat for optimal bioavailability, and suboptimal fat intake may contribute to perceived treatment failure or relapse.

He also reviews evolving data on dosing strategies, noting that a range of daily doses can achieve clearance. The priority, however, is durability of response. Clinicians are encouraged to focus on cumulative exposure and to individualize therapy, extending duration or adjusting dose as needed to maintain clearance. Newer formulations, including lidose and micronized isotretinoin, may help mitigate variability in absorption and improve consistency, though access and cost remain considerations.

Additional insights address relapse risk and the importance of evaluating possible underlying contributors such as androgen excess. Laboratory monitoring practices have also evolved, with a more streamlined approach focusing on key parameters like liver enzymes and triglycerides, alongside strict adherence to pregnancy prevention protocols.

Ultimately, the episode reinforces that while isotretinoin prescribing has modernized in certain respects, many core principles remain unchanged. Thoughtful dosing, attention to absorption, and individualized management are essential to optimizing long-term outcomes.

Tune in to the episode to revisit the clinical foundations of isotretinoin, refine your approach to dosing and duration, and learn practical strategies for improving treatment consistency and long-term acne clearance.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Leon Kircik, MD, for a wide-ranging conversation that traces Dr Kircik’s journey from his upbringing in Turkey to building a thriving dermatology practice and research center in Louisville, Kentucky, and ultimately becoming one of the leading educators in the field. 

Dr Kircik reflects on the early influence of his father, whose emphasis on discipline and hard work shaped his approach to both medicine and business. After immigrating to the United States and completing dermatology training at the University at Buffalo, he recognized an oversaturated market in New York City and made the strategic decision to establish his practice in Louisville. There, he prioritized including access for Medicaid patients and offered extended hours to better meet patient needs.

The discussion also explores the operational realities of running a high-functioning clinical research center. Dr Kircik shares insights into meeting both the administrative and logistical demands, particularly in the context of clinical studies, highlighting the importance of protocol adherence, consistent investigator presence, and delivering high-quality data to maintain industry trust.

A notable portion of the conversation focuses investigator-initiated studies (ISS). While resource-intensive and carrying greater responsibility, Dr Kircik views ISS as an opportunity to answer clinically meaningful questions that industry-sponsored trials may not be able to address, ultimately contributing to scientific advancement and professional growth.

Tune in to the episode to hear more of Dr Kircik’s reflections on building a multifaceted career as well as personal lessons ranging from real estate investments to maintaining professional commitments while recovering from a serious injury, all grounded in a consistent theme of resilience and sustained effort over time.

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.