Maui Derm NP+PA Summer 2021: June 26, 2021

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Neonates to Adolescents Pediatric Dermatology Update 2021

by R. Hunt, MD, and S. Fallon-Friedlander, MD

In this presentation, Raegan Hunt, MD, discussed neonate cases and relative clinical data pertaining to tinea faciei treated with oral griseofulvin, scaly annular erythematous, neonatal lupus erythematous (cardiac and cutaneous), granuloma annulare, and maculopapular cutaneous mastocytosis to demonstrate the importance of considering patient and family history, symptoms, and laboratory workups when making management decisions for this younger population.

In the following segment, Sheila Fallon-Friedlander, MD, focused on treating acne in young female patients, starting with the case of a 13-year-old whose acne did not improve after benzoyl peroxide treatment. Dr. Fallon-Friedlander used the above case to discusses how this population tends to either have poor adherence or overuse the products due to unsatisfactory results. Updates on dietary intervention, specifically avoiding dairy products, and the influence on acne were also presented. Additionally, Dr. Fallon-Friedlander explored the link between birth control and improved acne, suggesting norgestimate was best type for the skin condition and the overall wellbeing of the patient. Featured therapies for acne included clascoterone cream, tazarotene, and spironolactone.

 

Zebras in Dermatology

by S. Desai, MD; M. Zirwas, MD; T. Rosen, MD; and I. Frieden, MD

Ted Rosen, MD, began this segment with cases of two black patients who presented with white, itchy spots. Through patient data and tissue biopsies, Dr. Rosen established the above symptom was due to hypopigmented sarcoidosis/lesions; further, Dr. Rosen highlighted how conditions that include hypopigmented lesions affect patients of color.

Next, Matthew Zirwas, MD, reported three challenging cases that included trial and errors for treating a patient with 30 years of ongoing hand dermatitis, a patient with a worsening rash and swelling on their torso, neck, face, and arms due to a drug reaction to allopurinol, and a patient experiencing widespread blisters all over their body while being treated with a generic asacol.

Following Dr. Zirwas, Ilona Frieden, MD, reported the case of a 12-year-old patient with a recurrent inflamed cheek lesion. Through ultrasounds and incisional biopsy, Dr. Frieden found this lesion was the result of dermatofibrosarcoma protuberans.

To conclude, Seemal Desai, MD, described the case of a patient with hyperpigmented patches on the scalp and throughout the body that was linked to lichen planus pigmentosus and a case of a patient with annular red, itchy scaling in the groin area that was correlated to over-the-counter steroid use.

 

Cutaneous Oncology Update 2021

by T. Rosen, MD, and G. Martin, MD

In this session, George Martin, MD, and Ted Rosen, MD, discussed flaws in the current American Academy of Dermatology actinic keratosis (AK) guidelines, including UV protection methods, insufficient combination treatments, and recommendations for skin cryotherapy and red and blue light photodynamic therapy (PDT). Next, both physicians discussed the study design and tolerability and recurrence data for 1% tirbanibulin treatment for AK lesions. After, using efficacy data from clinical trials, Dr. Martin described clearance rates following ALA PDT treatments. Actinic cheilitis was the next subject the speakers highlighted using specific patient cases. To end this segment, Dr. Rosen and Dr. Martin discussed cases of AK on various parts of the body, involving scalp, arms, and hands, and how to treat patients who are high-risk.

Maui Derm NP+PA Summer 2021: June 25, 2021

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Update on Infectious Disease 2021

by T. Rosen, MD, and S. Fallon-Friedlander, MD

Ted Rosen, MD, reviewed the current literature on various infectious diseases, beginning with nail and cutaneous manifestations of COVID-19. Next, Dr. Rosen discussed zoonotic diseases, mainly the Seoul virus that is contracted from rats. Research on therapeutic candidates for Zika virus, such as tetracyclines, were then discussed. After, publications on the use of intralesional cidofovir and intralesional antigens (e.g., candida, measles, mumps, and rubella [MMR], and purified protein derivative [PPD] antigens) for warts in patients who are immunocompromised were shared. Dr. Rosen also reported the case of a festering bacterial infection on a patient’s leg, that was accompanied by fever and widespread pain, to present the novel scoring system for necrotizing fasciitis. Moving onto fungal infections, Dr. Rosen explored cases and therapeutic experiences pertaining to cutaneous sporotrichosis prevalence, topical 1% encapsulated terbinafine gel for tinea capitis, and efinaconazole 10% solution for onychomycosis. Oral clarithromycin for the treatment of old world leishmaniasis, palmar involvement in scabies cases, tick-borne pathogens (e.g., Lyme and anaplasmosis) spreading from California were reviewed in the insect portion of this segment. To end, Dr. Rosen briefly touched on the future of human immunodeficiency virus infection (HIV) vaccine development.

Following Dr. Rosen, Sheila Fallon-Friedlander, MD, reviewed updated data on the prevalence and subset manifestations of/relating to COVID-19 in pediatric populations, including children hospitalizations based on patient characteristics, multisystem inflammatory syndrome mucocutaneous disease, a variety of rash presentations, and COVID toes and chilblain-like lesions. Next, Dr. Fallon-Friedlander highlighted literature on the link between myocarditis and the COVID-19 vaccine in younger populations. Head and neck dermatitis cases, particularly about dupilumab-induced rashes, scalp rashes from Trichophyton soudanense, scaling scalp lesions from Trichophyton verrucosum, and various sources of tinea capitis development, concluded this segment.

 

Disorders of Pigmentation

by S. Desai, MD

To begin this presentation, Seemal Desai, MD, reviewed the basis of melanin, how it influences the color of skin, the mechanism of melanocyte, the four steps of melanogenesis, and stages of melanosome maturation. Next, Dr. Desai discussed the causes and differential diagnosis of hyperpigmentation (i.e., post-inflammation, melasma, solar lentigines, and freckles) and hypopigmentation (i.e., vitiligo and albinism). Using patient cases and photos and clinical data, Dr. Desai shared clinical pearls when diagnosing and treating certain pigmentation disorders. Treatments for melasma were discussed, including hydroquinone, azelaic acid, kojic acid, kojic acid dipalmitate, methimazole, tranexamic acid treatments, and chemical peels (e.g., glycolic, salicylic, and trichloroacetic acids). For the remainder of this segment, Dr. Desai covered active/unstable, chronic, and refractory vitiligo and relative treatment options, including dexamethasone, oral mini-pulse therapy, calcium/vitamin D supplements, alpha-lipoic acid supplements, phototherapy, tacrolimus, Polypodium leucotomos, and JAK-inhibitors (oral tofacitinib and ruxolitinib, 1.5% cream). To end, Dr. Desai described the case of a patient with progressive macular hypomelanosis and how it was treated with 10% benzoyl peroxide.

 

Acne and Rosacea Update 2021

by J. Harper, MD; H. Baldwin, MD; and R. Hunt, MD

To begin, Raegan Hunt, MD, described three pediatric cases involving the etiology and clinical findings for neonatal “acne” and infantile “acne.” Additionally, Dr. Hunt listed the many ways isotretinoin can be given to infants and babies, for more difficult cases. Following, Dr. Hunt reviewed the cases of a 2- and 4-year-old with mid-childhood “acne” to depict how this skin presentation tends to be indicative of other underlying disorders, typically of the endocrine variety. Pre-adolescent acne was also discussed. To end, Dr. Hunt explored acne in transgender youth, specifically the risk of acne development and/or exacerbation of acne with gender-affirming treatments.

Using the case of a patient with moderate-to-severe acne that affected different parts of the body and became more severe as they aged, became pregnant, suffered from post-partum depression, and endured perimenopausal years, Hilary Baldwin, MD, described methods and factors (i.e., age, sex, adherence, and child-bearing and menopausal years) to consider when making treatment and management decisions for this skin condition. Through this case, Dr. Baldwin discussed increasing C. acnes resistance rates and the decrease of oral antibiotic development, as well as the importance of developing an “exit” strategy for patients with moderate-to-severe acne being treated with an oral antibiotic to avoid C. acnes resistance. Dr. Baldwin also provided suggestions for treating patients with acne who plan on becoming pregnant/who are pregnant and treating patients with post-partum depression and who are breastfeeding. Tazarotene 1.5% lotion at 11 years, combination benzoyl peroxide 2.5% and adapalene at 13 years, trifarotene at 17 years, isotretinoin at age 18 years, spironolactone at age 27 years, and trimethoprim-sulfamethoxazole at 31 years were some of the patient’s treatments mentioned by Dr. Baldwin.

Next, Julie Harper, MD, highlighted why patient-reported signs and symptoms, triggers, and treatment goals should be kept in mind when forming treatment strategies for patients with rosacea. Using clinical data and patient outcomes, Dr. Harper reported select therapies for elements of rosacea, such as beta-blockers (e.g., carvedilol, nadolol, and propranolol) for flushing, botulinum toxin for facial erythema, brimonidine 0.33% gel (and/or in conjunction with ivermectin) for persistent facial erythema, and oxymetazoline 1% cream for inflamed papules and pustules and facial erythema.

Maui Derm NP+PA Summer 2021: June 24, 2021

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New Drugs and Therapies for 2021

by T. Rosen, MD

In this presentation, Ted Rosen, MD, reviewed various novel drugs and therapies being developed and/or released throughout 2021, discussing their efficacy, mechanism of action, dosing, and safety data from referenced clinical trials. Additionally, Dr. Rosen provided updates on preexisting treatments. Featured therapies that were thoroughly explored included oteseconazole for candidiasis, lonafarnib for progeria, berotralstat for hereditary angioedema, ligelizumab for spontaneous urticaria, ansuvimab and Inmazeb for Zaire ebolavirus, tirbanibulin, and patidegib gel. Dr. Rosen concluded the presentation by listing updates in potential upcoming therapies for scleroderma.

 

Psoriasis and Psoriatic Arthritis 2021

by B. Strober, MD, PhD; A. Kavanaugh, MD; and M. Young, MSN, A/GNP-c

Bruce Strober, MD, PhD, presented new psoriasis therapies, starting with the efficacy and safety of apremilast from the ADVANCE trial. Following this, Dr. Strober provided updates for the TYK2-inhibitor deucravacitinib, comparing it to apremilast clinical outcomes. Then, Dr. Strober reviewed the clinical efficacy of bimekizumab and highlighted the safety updates on interleukin (IL)-17 and IL-23 inhibitors, namely ixekizumab, secukinumab, ustekinumab, guselkumab, and risankizumab. Next, Arthur Kavanaugh, MD, reviewed the etiopathogenesis of psoriatic arthritis and offered screening criteria and available treatment options for the above condition and related nail involvement. After, Melodie Young, MSN, A/GNP-c, reported tough-to-treat patient cases, mainly pertaining to scalp, nail, and palmoplantar psoriasis.

 

Atopic Dermatitis Update 2021

by E. Simpson, MD, and L. Eichenfield, MD

For the last session of Day 1, Lawrence Eichenfield, MD, shared clinical updates in topical treatments for atopic dermatitis, beginning with the efficacy, safety, and patient outcome data for crisaborole, tacrolimus, Janus kinase (JAK) inhibitors (e.g., ruxolitinib, delgocitinib), and tapinarof cream. Following Dr. Eichenfield, Eric Simpson, MD, MCR, presented available systemic treatments for adults with atopic dermatitis and reviewed therapeutic decision-making processes, factors to consider when choosing a systemic treatment, and the spectrum of adult atopic dermatitis. Through patient cases, the advantages and disadvantages of using dupilumab and emerging therapies for atopic dermatitis, including tralokinumab and abrocitinib, were highlighted here.