Attention to Lupus is Long Overdue! Better Understanding of Disease Leads to Better Therapies

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.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes David Seiter, FNP-C, for a wide-ranging discussion on challenging dermatologic dogma and integrating emerging evidence into clinical decision-making. They begin with Seiter sharing his approach to reviewing new literature, encouraging clinicians to look beyond mainstream dermatology journals to cross-disciplinary publications to help reshape long-held assumptions. Using lichen planus as an example, he revisits the entrenched association between diffuse lichen planus and hepatitis C. While many clinicians routinely test for hepatitis C in these patients, new data suggest the association is uncommon. More compelling, however, is the emerging link between persistent, widespread lichen planus and underlying malignancy. Seiter outlines how he thoughtfully screens for red flags and gaps in preventive care without alarming patients prematurely, reinforcing the importance of looking beyond a single lab test. The conversation then shifts to acanthosis nigricans, where traditional teaching centers on hyperglycemia and diabetes risk. Seiter explains why acanthosis nigricans is more accurately viewed as a marker of hyperinsulinemia rather than elevated A1c. He discusses incorporating HOMA-IR calculations to identify early insulin resistance, particularly in adolescents whose A1C may remain normal for years. Both clinicians stress that a “normal” A1C should not prematurely reassure patients when cutaneous markers signal metabolic risk. Additional topics include reconsidering intralesional triamcinolone as the default therapy for keloids, with discussion of emerging data on intralesional insulin as a potentially lower–adverse event alternative, and a pragmatic conversation about JAK inhibitor safety. Comparing adverse event data across agents, they emphasize individualized risk assessment, careful monitoring, and shared decision-making over reflexive fear of boxed warnings. Tune into the episode to explore how questioning assumptions, broadening your literature review, and contextualizing risk can sharpen your clinical reasoning and elevate patient care in everyday dermatology practice.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Lisa Swanson, MD, to explore how acne management continues to evolve and how newer topical therapies can be integrated thoughtfully from the outset. They begin with Dr Swanson highlighting an important clinical reality: acne is presenting at increasingly younger ages, prompting earlier conversations about skin care routines and long-term strategies. At the same time, dermatologists now have several truly novel topical options, an uncommon development in acne therapeutics over the past decade. Using a typical adolescent patient as a reference point, she then outlines the range of options she reviews in clinic: foundational topical regimens (retinoids, benzoyl peroxide combinations, clascoterone, topical minocycline foam, or fixed triple combinations), selective short courses of oral antibiotics, consideration of oral probiotics based on emerging data, and hormonal approaches in appropriate female patients. She emphasizes tailoring mechanisms when combining therapies; for example, pairing hormonal therapy with a topical that offers a complementary pathway. Dr Del Rosso revisits the 4 pillars of acne pathophysiology, highlighting androgen-driven sebum production as an upstream contributor. This leads to a focused discussion on clascoterone as the first topical androgen receptor inhibitor and how targeting sebum early may alter lesion development. Both clinicians stress that clascoterone is best viewed as foundational rather than adjunctive therapy, emphasizing the importance of setting realistic expectations on time to peak efficacy. The conversation also covers tolerability, barrier considerations, twice-daily adherence, and admixture data with common topical agents. Clinical pearls include setting early follow-ups to reinforce adherence, aligning office staff messaging, and using shared decision-making to balance patient priorities like oil control and pore appearance with mechanistic treatment goals. Tune in to the episode to hear real strategies for initiating acne therapy with intention, integrating newer topicals early, and guiding patients toward regimens that are both physiologically sound and sustainable in everyday practice.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Steven Daveluy, MD, for a wide-ranging conversation that connects oncodermatology, teledermatology, and integrative approaches to patient care. The discussion opens with Dr Daveluy’s work in an oncodermatology clinic and the critical role dermatologists play in managing cutaneous side effects from cancer therapies. He explains that while oncologists may be inclined to pause or discontinue cancer treatment in the face of severe skin reactions, dermatologists are uniquely positioned to identify, manage, and mitigate these effects, often allowing patients to remain on life-saving therapy and achieve better oncologic outcomes. The conversation then shifts to teledermatology, highlighting the Veterans Affairs health system’s leadership in expanding access, particularly for rural patients. Dr Daveluy describes his team-based model in which dermatoscopy is standardized across sites, allowing frontline clinicians to submit high-quality images for rapid dermatologic input. Clinical pearls follow, including management of epidermal growth factor receptor-inhibitor eruptions with tetracyclines and selective use of agents such as isotretinoin or dapsone to keep patients on cancer therapy. Importantly, brisk skin reactions may correlate with positive tumor response, reinforcing the goal of treating through, rather than stopping, therapy. The episode concludes with an exploration of integrative dermatology. Dr Daveluy advocates for consideration of evidence-based supplements, thoughtful discussion of diet and stress, and careful counseling rather than dismissing patient interest. Case examples illustrate both benefit and harm, underscoring the importance of third-party testing and drug–supplement awareness. A final reflection on mind-body medicine through practices like “laughter yoga” highlights tools that can help patients reframe flares and improve quality of life, even when disease activity is beyond their control. Tune in to the episode to hear expert insights on managing cancer-therapy–related skin reactions, expanding access through teledermatology, and thoughtfully integrating complementary approaches into everyday dermatology practice.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, sits down with Laura Ferris, MD, to explore the path to, and realities of, serving as a department chair in academic dermatology. They begin with Dr Ferris describing the motivations that led her to consider a leadership role, sharing the self-reflective questions that guided her thinking, including how to continue growing professionally, how care delivery can be improved, and where she could make the greatest long-term impact. The conversation then turns to stepping into the chair role itself. Dr Ferris introduces the idea of a “listening tour,” and the value of meeting with faculty and staff early, understanding what matters most to them, and easing fears that change will disrupt what they value in their work. She stresses that a department’s success depends on shared ownership, not top-down decision-making. They next discuss building productive relationships beyond the academic setting, particularly with community dermatologists. Dr Ferris describes her department’s noncompetitive approach, focusing on clinical excellence, referral partnerships, and aligning care so patients are matched with the right expertise. A key portion of the discussion centers on working effectively with advanced practice providers (APPs). Dr Ferris outlines her department’s physician-to-APP model, highlighting mentorship, collaboration, and thoughtful delegation to ensure high-quality care. The episode concludes with Dr Ferris sharing her goals for the future, including reducing silos, strengthening integration between clinical care and research, expanding translational efforts, and improving access for underserved and rural populations through tools like e-consults. She emphasizes the importance of engaging faculty, residents, and learners in shaping a shared vision and turning ideas into action. Tune in to the episode to hear practical leadership insights, real-world lessons on collaboration, and thoughtful perspectives on guiding a dermatology department through growth and change.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Lauren Madigan, MD, associate professor of dermatology at the University of Utah, for a focused exploration of mast cell disease, an often underrecognized but clinically significant group of disorders that dermatologists may encounter on the front lines. The conversation begins with mast cell biology, including their origin in the bone marrow, tissue-specific phenotypes, and roles beyond classic allergic disease. Dr Madigan explains how mast cells contribute to immune defense and wound healing, with Dr Del Rosso noting how infrequently they are discussed in routine dermatology training despite their relevance across multiple conditions. They then explore mastocytosis across the age spectrum, contrasting pediatric presentations (many of which remit by adolescence) with adult-onset disease, where cutaneous findings often signal systemic involvement. Dr Madigan reviews current National Comprehensive Cancer Network guidance, emphasizing that most adults presenting with cutaneous mastocytosis will have some degree of systemic disease and may warrant more detailed testing for accurate staging, prognostic differentiation, and management choices. The discussion highlights the heterogeneity of systemic mastocytosis, from indolent forms to advanced disease with organ involvement or associated hematologic neoplasms. The episode also covers practical diagnostic and workup considerations, including laboratory evaluation, KIT mutation testing, and biopsy considerations. Dr Madigan stresses the importance of experienced dermatopathology interpretation and thoughtful site selection to optimize diagnostic yield. Treatment strategies are discussed through a pragmatic lens, ranging from symptom-directed therapies to cytoreductive and targeted tyrosine kinase inhibitors, with an emphasis on individualized care based on disease subtype, symptomatology, and prognosis. The episode closes with resources to help dermatologists navigate diagnostic assistance and treatments via specialty centers and clinical trials. Listen to the episode to deepen your understanding of mast cell disease, sharpen your diagnostic approach, and gain practical guidance on evaluation, staging, and management strategies, both for real-world practice and for determining when referral to specialized care is warranted.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Zoe Draelos, MD, for an in-depth discussion of 3 practical questions surrounding topical clascoterone, informed by studies Dr Draelos helped conduct. Together, they translate study findings into real-world considerations for using clascoterone as part of combination acne regimens. The conversation begins with the role of formulation and vehicle design, addressing a common concern in acne management: barrier disruption and application-site irritation. Unlike retinoids or benzoyl peroxide, clascoterone is an androgen receptor inhibitor formulated in a vehicle shown to sustain and slightly increase moisture content in the skin, supporting  barrier function while remaining compatible with other topical acne therapies. Data evaluating transepidermal water loss and corneometry demonstrate that the finished, marketed formulation sustains skin moisturization, reinforcing its barrier-friendly profile. The discussion then turns to real-world use, where clascoterone is frequently combined with other topical agents. An admixture stability study examined whether clascoterone degrades, or causes degradation of, commonly used acne treatments such as benzoyl peroxide, clindamycin, adapalene, and retinoids. Using chromatographic and mass spectrometric analysis, the study confirmed that clascoterone remains stable and compatible when layered with these agents. Finally, Dr Draelos reviews clinical data demonstrating progressive sebum reduction in patients with mild to moderate acne, measured using standardized sebumeter technology. Sebum levels decreased beginning around 12 weeks and continued to decline through 52 weeks, paralleling reductions in acne lesions, oily appearance, and visible pore size. Together, these findings clarify how clascoterone works at the target organ level and why its clinical benefits extend over time. Tune in to the episode to hear how these studies answer key mechanistic and practical questions about clascoterone, and how its barrier-friendly formulation, combination compatibility, and sustained sebum reduction may inform everyday acne management in clinical practice.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Nicholas Brownstone, MD, practicing dermatologist and host of the Cutaneous Miscellaneous podcast, for a case-based discussion on how dermatologists think through challenging presentations and refine their diagnostic approach. Together, they offer takeaways that residents, early-career dermatologists, and experienced clinicians alike can apply when faced with complex or ambiguous cases. The episode opens with a challenging pustular eruption in a 30-year-old male initially labeled as Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Through a stepwise reassessment, the discussion walks through acute generalized exanthematous pustulosis versus generalized pustular psoriasis, highlighting latency periods, biopsy limitations, recurrence patterns, and the clinical clues that ultimately prompted a shift in diagnosis and management. The case also surfaces practical access barriers, including insurance denial of spesolimab due to tuberculosis testing requirements, and explores how evolving guidance contrasts with current labeling realities. Subsequent cases broaden the scope to mucocutaneous eruptions, clarifying distinctions among erythema multiforme, Mycoplasma-induced rash and mucositis/reactive infectious mucocutaneous eruption, and SJS/TEN. A key takeaway discussed is the importance of prioritizing drug causality when classic triggers and timelines are present, even in the setting of concurrent infection, to avoid potentially catastrophic outcomes. The final case focuses on neonatal lupus and explores how recognizing characteristic cutaneous findings can lead to appropriate evaluation for systemic involvement and timely referral, even when skin disease itself is self-limited. Tune into the episode to follow expert clinicians as they reason through diagnostic uncertainty, rethink initial assumptions, and highlight the small diagnostic details that can meaningfully change disease management.

In this 2025 Year in Review solo episode of Derms and Conditions, host James Q. Del Rosso, DO, reflects on the standout conversations, clinical insights, and new formats that shaped the series over the past year. Dr Del Rosso opens by highlighting the launch of Tea with Dr. D, a sister vodcast that brings expert discussions to video, incorporating slides and procedural footage. He spotlights an episode with HS expert Lauren Lam, MD, who walks through comprehensive hidradenitis suppurativa management from patient check-in through long-term care. He also reviews Spilling the Tea with Dr. D, a hybrid audio-video mailbag format that addresses listener-submitted clinical questions. He then revisits key moments from the core Derms and Conditions series, beginning with Michael Payette, DO, who discussed building a dedicated HS clinic, collaborating with nondermatology providers, and his early adoption of GLP-1 agents for inflammatory disease management. Additional highlights include an episode with E. James Song, MD, on modern nb-UVB phototherapy units and practical guidance for safe implementation, as well as a unique discussion with Clay Cockerell, MD, JD, on estate planning considerations for physicians. Vitiligo emerged as a recurring focus in 2025, with expert insights from Seemal Desai, MD, and Pearl Grimes, MD, covering disease assessment, treatment timelines, topical ruxolitinib, oral therapies, phototherapy, and running a dedicated vitiligo center. Dr Del Rosso also revisits episodes on extended-release minocycline for rosacea, oral JAK inhibitors in older adults, challenging case-based discussions, evolving approaches to photoprotection and skin care counseling, and emerging therapies across alopecia areata, hyperhidrosis, tyrosine kinase 2 inhibition in psoriasis, and chronic hand eczema, including a recent FDA approval. Tune in to the full episode for a look back at a year of clinically relevant education aimed at supporting dermatologists in everyday practice.