Derms and Conditions

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes E. James Song, MD, to discuss the clinical utility of narrowband UVB (NB-UVB) phototherapy and how advances in home-based devices are addressing longstanding barriers to its use. From psoriasis and vitiligo to atopic dermatitis and other inflammatory skin conditions, they examine where phototherapy fits into modern treatment strategies and how guided home-based treatment can expand access while reducing the burden on patients and practices.

Dr Song begins with an overview of the UV spectrum and why NB-UVB, particularly wavelengths of 311 to 313 nm, offers a favorable balance of therapeutic efficacy and tolerability. The discussion then turns to advances in home phototherapy technology, including a device that uses patient-reported responses to previous treatments to automatically calculate subsequent doses. Referencing findings from the LITE trial, which compared home-based and office-based phototherapy for psoriasis, the clinicians discuss the evidence supporting the safety, effectiveness, and improved treatment adherence associated with home use.

Beyond psoriasis, Dr Song highlights applications in atopic dermatitis, cutaneous T-cell lymphoma, and pruritic conditions, with particular emphasis on the underutilization of NB-UVB in vitiligo. He describes its potential to complement topical and systemic therapies, encouraging clinicians to consider phototherapy as an adjunct rather than an alternative to other treatment modalities.

The conversation also addresses practical considerations for incorporating home phototherapy into clinical care, including prescribing workflows, insurance coverage, and access for patients who live far from treatment centers. Drs Del Rosso and Song review important precautions involving photosensitizing conditions and medications, along with practical strategies for optimizing treatment response, including the use of emollients and adjustments to patient positioning.

Tune in to the episode for a closer look at how home-based NB-UVB phototherapy is changing the logistics of light-based treatment, the clinical scenarios in which it may be particularly valuable, and what dermatologists should know when incorporating it into patient care.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Cory Rubin, MD, for a candid look at the business of dermatology. Drawing on his experience building an independent practice, Dr Rubin discusses what it takes to move from clinician to practice owner, from the freedom to pursue new opportunities to the responsibility of leading a team, managing finances, and making decisions that extend far beyond patient care.

Dr Rubin begins by sharing what motivated him to establish his own practice, including his interest in complex medical dermatology and clinical research and his desire for greater freedom to pursue those interests. He emphasizes that independence comes with significant responsibility: Practice ownership requires commitment, resilience, and a willingness to accept both the benefits and consequences of the decisions you make.

The conversation turns to lessons Dr Rubin has learned as a leader. While clinical practice often rewards quickly identifying a problem and acting on it, he found that business decisions sometimes require slowing down, listening, and allowing time before choosing a course of action. He discusses the importance of consistency in setting expectations for staff, developing a strong workplace culture, and training PAs and NPs over time rather than expecting immediate independence.

Drs Del Rosso and Rubin also explore the operational considerations of incorporating clinical research into a dermatology practice, including the need for appropriately trained research staff and clear separation of clinical and research functions. They close with Dr Rubin’s approach to structuring interactions with pharmaceutical representatives and his broader perspective on practice ownership as an ongoing process of adaptation and learning.

Tune in to the episode for an inside look at the realities of building and running a dermatology practice, the lessons that come with leadership, and why setbacks can become some of the most valuable experiences for a practice owner.

In this episode, host James Q. Del Rosso, DO, welcomes dermatologist and rheumatologist Joseph Merola, MD, to discuss the diagnosis and management of dermatomyositis (DM). From subtle cutaneous clues and systemic involvement to malignancy risk, myositis-specific antibodies, and an expanding treatment pipeline, Dr Merola highlights what dermatologists should recognize when DM enters the differential.

DM can present with classic findings such as Gottron papules, heliotrope rash, and the shawl sign, but other clues may be less obvious. Dr Merola discusses pruritic scalp disease, eyelid edema, linear extensor erythema, and nailfold capillary changes, as well as photodistributed eruptions that may be difficult to distinguish from cutaneous lupus. Beyond the skin, he outlines 5 areas to consider when evaluating patients with DM: cutaneous findings, muscle weakness, inflammatory arthritis, lung involvement, and malignancy.

The conversation moves from clinical assessment to diagnostic workup, including evaluation of proximal muscle weakness, the importance of asking about dysphagia, and the role of CK and aldolase. Dr Merola also explains when EMG, MRI, or muscle biopsy may add value and when classic skin findings combined with weakness and/or elevated muscle enzymes may provide sufficient diagnostic information.

Dr Del Rosso and Dr Merola also discuss malignancy risk and the clinical information provided by myositis-specific antibodies. Anti-TIF1γ and anti-NXP2 can signal greater malignancy risk, while anti-MDA5 is associated with clinically amyopathic disease and heightened concern for interstitial lung disease. Dr Merola considers how these findings can help inform risk assessment, screening, and collaboration with rheumatology and other specialties.

Finally, they review the treatment of both cutaneous and muscle disease, from photoprotection and established systemic therapies to JAK inhibition and emerging targeted treatments. Dr Merola reflects on a growing therapeutic pipeline* for a disease in which cutaneous involvement, in particular, has historically been challenging to manage.

Tune in to the episode for a clinically focused discussion of recognizing dermatomyositis, assessing systemic and malignancy risk, interpreting antibody profiles, and navigating treatment as new therapeutic options emerge.

*This episode was recorded prior to FDA approval of brepocitinib. The FDA has since approved brepocitinib for use in the United States.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Darrell Rigel, MD, MS, for a discussion of photoprotection, sunscreen regulation, and how dermatologists can help patients make informed choices about sun protection.

Dr Rigel begins by examining why melanoma prevention requires attention to both primary and secondary prevention. While reducing UV exposure and using sunscreen can help lower risk, early recognition and access to dermatologic care remain critical once a suspicious lesion develops. He discusses geographic differences in melanoma incidence and mortality in the United States and how factors such as UV exposure and access to care can contribute to these patterns.

The conversation then traces the complicated regulatory history of sunscreens in the United States. Dr Rigel reviews developments from the emergence of higher-SPF products in the 1980s through subsequent FDA monographs, debates surrounding the safety and systemic absorption of sunscreen filters, and legislation intended to accelerate review of new ingredients. He explains how this history has contributed to the United States having fewer available UV filters than other parts of the world.

A significant recent development is bemotrizinol, a broad-spectrum, photostable UV filter that has undergone extensive FDA-requested testing. Dr Rigel discusses its coverage across UVB and UVA wavelengths, cosmetic properties, and potential to expand sunscreen formulation options in the United States.*

Drs Del Rosso and Rigel also address how clinicians can evaluate sunscreen products and counsel patients amid persistent misinformation. They discuss the importance of appropriate product testing, selecting products patients will actually use, and providing guidance on application of sprays, sticks, and other formulations.

The discussion also considers photoprotection in patients with darker skin tones, including melanoma risk, UVA-associated dyspigmentation, and the importance of cosmetically acceptable formulations that minimize visible residue or white cast.

Tune in to the episode to hear Drs Del Rosso and Rigel discuss the science and regulation behind modern sunscreens, strategies for addressing patient misconceptions, and ways to make consistent photoprotection more achievable across a range of skin types and patient preferences.

*Editor’s note: This episode was recorded prior to FDA approval of bemotrizinol. The FDA has since approved bemotrizinol for use in the United States.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, delivers a solo “Spilling the Tea” segment exploring clinical observations that may warrant a closer look. He examines dermatomyositis findings that can mimic more common conditions, nuances in prescribing language, the importance of a thorough hidradenitis suppurativa (HS) examination, and an unexpected case of rhabdomyolysis, highlighting details that can change how clinicians approach diagnosis and patient management.

Dr Del Rosso begins with scalp pruritus as a potential manifestation of dermatomyositis. He reviews images showing how scalp involvement may resemble seborrheic dermatitis or psoriasis, with findings such as erythema, scaling, and hair thinning. He also examines nailfold changes, including prominent capillaries, capillary dropout, and abnormal cuticles, that can provide additional diagnostic clues. Recognizing these findings is particularly important given the potential systemic implications of dermatomyositis.

The discussion then turns to limitations of use in prescribing information stating that certain therapies are “not recommended” in combination with other agents. Dr Del Rosso distinguishes this language from a formal contraindication and discusses the importance of understanding the evidence behind labeling when making treatment decisions.

In HS, he emphasizes the value of a complete skin examination, including areas patients may initially be reluctant to expose. Assessing and palpating lesions can help distinguish active inflammatory findings, including abscesses, nodules, and draining tunnels, from established fibrotic or scarred disease.

Finally, Dr Del Rosso shares the case of a 42-year-old woman receiving JAK inhibitor therapy who developed markedly elevated creatine kinase and rhabdomyolysis. Although her medication presented one possible explanation, further investigation revealed that she had gone several weeks without levothyroxine for hypothyroidism, another potential contributor. The case illustrates the importance of considering the full clinical picture when evaluating an unexpected finding or adverse event.

Tune in to the episode for clinical observations that encourage a closer look at what may initially seem straightforward, from recognizing less familiar disease presentations and interpreting prescribing information precisely to conducting a thorough examination and considering multiple explanations for an unexpected finding.