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Happy Spring, Medscape Readers! Last month we wrapped up MedscapeLive! Hawaiian Dermatology Seminar. The conference was a packed 6 days, with 15 sessions, bonus presentations, CME symposia, receptions, hands-on workshops, and multiple fantastic collaborative panels. Dr. Linda Stein Gold, who co-chairs Hawaii Derm, shared, “With so many new drugs recently approved, it is great to hear all of the critical safety and efficacy information from those who have actual firsthand knowledge.” Highlighting one of the seminar’s biggest selling points, she added: “I appreciate having all of the lectures in one place so that I don't have to choose between topics. I can hear everything!”

This month in Innovations in Dermatology, we speak to faculty who bring a critical knowledge of new research and best practices to Hawaii Derm. Read on for some sneak peek clinical pearls from their presentations. 

Register now! For the upcoming Inaugural Pigmentary Disorders Exchange Symposium 

JW Marriott • Chicago, May 5-6, 2023

  • From the producers of ODAC Dermatology, Aesthetic, and Surgical Conference and Skin of Color Update. 
  • One-of-a-kind, 2-day event with an intense and pearl-packed agenda covering pigmentary disorders in the full spectrum of skin tones, from lightest through darkest.
  • With interactive exhibitions, live-patient injection sessions, workshops, talkbacks and other surprising new formats, you’ll return to practice with information that will make an immediate impact on patient care. 
  • From vitiligo, melasma, hyperpigmentation and photodamage to the less common pigmentary disorders, world renowned experts in the field will leave no stone unturned 
  • Each session will include patient cases, thought-provoking discussions and interactive Q&A.
  • To register, click here!

Save the Date as well for the 46th Annual Hawaii Derm, which will be during Presidents’ Week 2024. Keep current on new publications with our Derm Resource section below, with articles from JAMA Dermatology, Dermatology News, Cutis, NEJM and more. Thank you to our faculty for their time and expertise. Happy Spring and happy reading!—Colleen Hutchinson

Faculty Pearls from Hawaii Derm

Rosacea round-up

Julie Harper: Patients don’t fit into a single subtype. Don’t even try to subtype them. Instead identify every feature of rosacea that is present and treat accordingly. Remember that our rosacea drugs are specialized. Agents for redness may not help with papules and vice versa. Most patients with rosacea will benefit from combinations of treatments and treatment modalities. 

Updates in Vitiligo

Dr. Hamzavi: Vitiligo has tremendous psychosocial effects on our patients, but they greatly vary across patients. Assess the well-being of your patients and then learn to manage expectations. All treatments take time but make sure patients are stable before initiating therapy by assessing for signs of instability and leukotrichia. Then pick the appropriate topical, phototherapy, systemic, or surgical option. For non-segmental vitiligo, maintain treatment at a reduced frequency to prevent recurrence. Watch for new treatments for vitiligo. They are coming. I am honored to be part of this meeting and look forward to it every year.

Hormonal Acne:

Julie Harper: All acne is hormonal! Spironolactone is a work horse for women with acne. The most common side effect is menstrual irregularities, and it is dose-related. If women are on an oral contraceptive or have an IUD, this side effect is unlikely, and you can feel confident using a higher dose if needed. 

Best Practices in Managing Actinic Keratosis

Dr. Neal Bhatia: “The approach to treating AKs by both dermatologists and patients is full of complaints and obstacles…Coverage is always an excuse with the response “We can treat these when you meet your deductible…” as a copout, even though patients with AKs are no longer just Medicare age,” he explained. “Dermatologists complain that combination therapies are never promoted by pharma, and neither are the strategies to managing reactions…as a result compliance is marginal. Yet the reality is generic drugs don’t have coupon cards or samples, which is irrelevant when dermatologists are fixated on reactions and not outcomes. “Just freeze and go” has unfortunately led to the bandage phenomenon of treating AKs rather than approaching the big picture of the disease of photodamage and AKs that lead to skin cancer. Just like “pre-boarding” a plane is still boarding, and “pre-diabetes” is a warning sign, dermatologists need to consider AKs more than just “pre-cancerous” because the appearance of one usually means that 10 more are on the way and skin cancer prevention needs to be a priority.  Incorporation of topical therapies, photodynamic therapy, and other chemoprevention strategies need to be part of the routine no matter which climate or age group the patients are in.”

Neonatal Dermatoses 101: What’s Normal and What’s Not:

Moise L. Levy: In a neonate, if you think of staph, think of herpes... you are less likely to miss the latter. With rash and failure to thrive in an infant/neonate, think of metabolic, immunologic disorders... it could still be severe atopic dermatitis or psoriasis, however.

Geno Derm in the Bottle? Management Advances With Genetic Diseases:

Dr. Levy: "PIK" your target... as in CLOVE(S) syndrome; targeting PIK3CA mutations can help with overgrowth. Also, in dermatology, as in other areas of medicine, the importance of genetic testing is clear when considering counseling AND potential treatment options.

Nevi and Skin Cancer in Children: What’s the Risk and How Do We Counsel?

Dr. Jennifer Huang: “Melanoma is a rare and important condition to diagnose in children. Dermatologists should be equipped to recognize and treat this condition early and provide appropriate individualized counseling regarding risk for melanoma and need for skin cancer surveillance.

Allergic Contact Dermatitis:

Dr. JiaDe Yu: “Hypersensitivity to aluminum in vaccines can cause granulomas that can be mistaken for more nefarious growths. Hypersensitivity to glucose monitors is increasingly reported and acrylates are usually to blame! Lanolin is the contact allergen of the year in 2023!”

Dr. Eichenfield: My biggest pearl is how to figure out when you are willing to take on newer medications or regimens of care during rapid evolutions in therapeutic options. We all have different “jumping off points.” As one of the Chairs of the conference, I always want our faculty to help each of us be more educated and comfortable with emerging technology, procedures, and medication, and help us to figure out “what’s right for my patients and practice.”

The Role of SLNB and GEP in Melanoma Diagnosis and Prognostication: 

Dr. Ferris: We covered data supporting the use of sentinel lymph node biopsy to give us prognostic information after a patient is diagnosed with melanoma, as well as some of the limitations of the procedure. We discussed how gene expression profiling may offer a way to non-invasively provide individualized prognostic information to guide next steps after a patient is diagnosed with melanoma. We also discussed both GEP and SLNB and their benefits and limitations in the context of the dramatic therapeutic advances in melanoma therapy that we have seen over the past decade.

Racial Morphology in Aesthetics: 

Dr. Saedi: With the social media obsession and over-exposure to the same look, we are seeing more and more people of different ethnicities looking similar.

Updates on Hidradenitis Suppurativa Treatments:

Dr. Hamzavi: Dermatologists are perfectly positioned to dramatically improve the lives of hidradenitis suppurativa patients by combining topical, procedural, and systemic therapy. Your goal is to prevent sinus tunnel formation, and if that happens, use procedures to reverse the progression. New FDA-approved options are on the way to supplement existing treatments.

COVID and Kids:

Dr. Lisa Arkin: If COVID has taught us anything, it’s that the host response to infection – not the virus itself—determines its outcome. More than 90% of kids in the US have had COVID. So, what kept them safe, with a mortality rate <0.009%, lower than the flu? To understand what kept children healthy during the pandemic, we first need to understand the critical immune response in SARS-CoV-2 infection, and we need to go back in time to understand the effect of a novel virus in an unvaccinated population.

Some takeaways from Dr. Yu’s second presentation, Recognizing and Treating Other Dermatoses, are: “Consider head and neck dermatitis due to Malassezia in atopics and patients on dupilumab. If a patient presents for patch testing and is in acute distress, think outside the box! Nature does not make straight lines, but external injury does.”

FAQs on Hyperhidrosis:

Dr. Robert Sidbury: “What is the most Frequently UnAsked Question (FuAQ?) about Hyperhidrosis? Answer: Do you sweat too much? Providers need to make it easy for patients—especially kids---to tell them about this problem that is often embarrassing or dismissed.”

He explained that patients with hyperhidrosis “get more skin infections than patients who sweat normally. We think about this with atopic dermatitis patients, but it is not necessarily top of mind with hyperhidrosis patients,” he stated. “It should be. Equip patients with the ability to recognize and treat possible complications of their hyperhidrosis like common skin infections.”

Are TNF Inhibitors Obsolete for Psoriasis? A Pro/Con Debate:

Dr. Andrew Blauvelt: “Numerous reviews and meta-analyses, utilizing a variety of methods, have shown that IL-17 and IL-23 blockers are more efficacious than TNF blockers. And we know that TNF blockers have a longer list of safety concerns compared to these two newer classes of drugs. Combined, these data provide strong evidence that an IL-17 or an IL-23 blocker should be utilized first for psoriasis, and not a TNF blocker, which are less efficacious and less safe.”

Dermatology Resource Section: 

Cutis Review: How to Advise Medical Students Interested in Dermatology: A Survey of Academic Dermatology Mentors


JAMA Dermatology Viewpoint: Double Standards and Inconsistencies in Access to Care—What Constitutes a Cosmetic Treatment?


NEJM Original Article: Two Phase 3 Trials of Lebrikizumab for Moderate-to-Severe Atopic Dermatitis


Medscape February 45th Annual Hawaiian Dermatology Seminar (Waikiki Beach Marriott, Honolulu, Hawaii) February 19-24, 2023


Dermatology News: Treatment of craniofacial hyperhidrosis


Cutis Article: Characterization of Blood-borne Pathogen Exposures During Dermatologic Procedures: The Mayo Clinic Experience


Cutis Original Research: Bridging the Digital Divide in Teledermatology Usage: A Retrospective Review of Patient Visits