Derms on Drugs

This week’s Derms on Drugs is a 6-pack that covers a little bit of everything and somehow lands on: just do what you want. From a randomized trial showing eczema doesn’t care how often you shower to wild dupilumab data—plus a heating pad “treatment” that might actually work and a new JAK/TYK2 raising eyebrows—this one is equal parts useful, questionable, and predictably unpredictable.

This week’s Derms on Drugs 6-pack moves past theory and into real decisions—what actually helps you pick the rightdrug for the patient in front of you. From gene expression profiling that predicts JAK vs Th2 response to the growing concern around dupilumab and CTCL, and more, this episode separates signal from noise—and gives you a few things you won’t forget (looking at you, abscopal effect).

Couldn't make it to Denver for the AAD conference? Made it to Denver but maybe had one too many Old Fashions to make it to the late breaking abstract presentations? DoD may have had too many Old Fashions (it was really only Dr. Zirwas), but we still made it to the session with all the hottest data in the world of dermatology. Join Drs. Zirwas, Ferris, and Patton for the first episode of this pair that'll keep you ahead of the curve.

The Derms on Drugs get schooled on Hidradenitis Suppurativa by Dr. Chris Sayed from the University of North Carolina. This will be one of the most practically useful sessions you've ever heard as we go way beyond the basics - we go way beyond basics like the biologics that don't work all that well.We'll get into a bunch of questions you probably haven't hear discussed with HS before:- What's the window of opportunity in HS and how do you keep it open?- Is there any such thing as mild HS?- What antibiotics actually work for HS and how do you use them?- Do ancillary treatments like spironolactone, metronidazole and oral roflumilast actually move the needle in a meaningful way?- If you're going to learn one surgical technique to really help your HS patients which procedure should you pick and how should you learn it?- What will be the likely role of JAK Inhibitors in HS?- Is it actually possible to get patients with long term, scarring severe HS better?

Matt, Laura, and Tim are joined by Dr. Lauren Graham (UAB) for a deep dive into cutaneous connective tissue disease. They cover the latest in lupus treatment — including the game-changing anifrolumab and its emerging sub-Q formulation — plus dermatomyositis workup, malignancy screening, the buzz around brepocitinib, and whether roflumilast deserves a spot as first-line therapy.

Big news on TB Tests for psoriasis patients on biologics! New official recommendations say not necessary for IL-17s and IL-23s. Literally zero cases. Ever. Think nicotinamide prevents skin cancer? Think again. Not saying it doesn't, but turns out data isn't really there and the jury is still out. How safe are topical steroids? Depends. Depends what else you're taking, especially NSAIDS - turns out it may increase your risk of an upper GI pretty substantially.If somebody doesn't respond adequately to Dupixent, what happens if you switch them to Rinvoq? Abbvie kind of answered the question, but not really.Just how well does Rhapsido work in CSU? And does it actually cause bleeding? No, no it does not. But we're understanding more and more about why it causes petechiae. Are PDE4 inhibitors like apremilast and roflumilast effective for bullous pemphigoid? Maybe. Do Sotyktu (and the new TYK2 inhibitors coming soon) work for atopic dermatitis? We got our first data and it looks like they are pretty great.

The Derms on Drugs are joined by Dr. Peter Lio to take a dive into the "root causes" of atopic dermatitis and what we can do to address them. Maybe you've heard about the "NICE" Axis - the Neuro-Immuno-Cutaneo-Endocrine Axis and thought you were on the cutting edge. Well, you're not. The new and updated model is the "SINGE" Network - the Skin-Immuno-Neuro-Gastro-Endocrine Network. Join us this week to get the answers to more of the questions you didn't know you should have!New data confirms again that elimination diets don't help with atopic dermatitis and data shows that avoiding foods makes you more likely so how do you talk to patients who are convinced food allergy is driving their atopic dermatitis?Should you be recommending probiotics to you atopic dermatitis patients (and which one)?How (and why) do probiotics work for atopic dermatitis?What does a lion in your basement have to do with atopic dermatitis?How do you handle patients who say that all moisturizers sting when you put them on?How do you deal with people in whom Staph aureus is playing a major role in their atopic dermatitis?What's coming for atopic dermatitis in 2026?

The Derms on Drugs bring in a heavy hitter straight out of silicon valley to talk AI and the future of dermatology. Dr. Faranak Kamangar is a Board Certified Dermatologist who founded, built and continues to improve DermGPT - a derm specific LLM that just outperformed ChatGPT in a head-to-head contest judged by dermatologists! As usual, we'll answer the questions you didn't know you had (well, maybe you knew you had some of these):Is AI going to make our lives easier or is it going to replace us?How good is AI at answering patient questions?Will patients accept "AI Providers"?How can you start levering AI now to make your life better?What AI tools are out there to start using right now?Are AI scribes all that great?

Get ready for a no-nonsense tour-de-force of practical application in the latest derm literature. Pipeline drugs, new approvals, brand names, generics—and HS data you’re better off ignoring (we’ll tell you why). In this episode:· Leqselvi: the newest JAK for alopecia areata—actually different, or more of the same?· HS & spondyloarthritis: are you screening… should you be?· JAKs and the heart: are all cardiovascular risks created equal?· “2/3 HS remission” headlines: why this data shouldn’t change your practice· Tirbanibulin + cryo for AKs: combo win or marketing math?· Hydrochlorothiazide & skin cancer: do you really need that conversation?· Oral minoxidil + Olumiant: synergy or wishful thinking in AA?· OX40/OX40L blockers: exciting pathway—new hope or new hype? Fast. Practical. Slightly skeptical (for good reason).If you prescribe, counsel, or roll your eyes at bad data—this one’s for you.

Admit it—bad hair days are the worst. Now imagine every day is one. Alopecia’s psychological impact is way deeper (and more surprising) than most people think. This week, the Derms on Drugs sit down with Harvard’s Dr. Maryanne Makredes Senna to unpack the mental side of AA—and then dive into what to do when a JAK inhibitor just… doesn’t JAK. As always, we’re answering the questions you didn’t even know you had.Here’s what we’re tackling:What hits harder on anxiety and depression—scarring or non-scarring alopecia?How tightly does AA severity track with psychological burden?How should you approach the mental health effects of AA?(Yes, you should ask. No, you shouldn’t be the one treating—here’s how to bridge patients to the right therapists.)And what do you do when a JAK Inhibitor isn’t giving you the results you hoped for?

The Derms on Drugs are joined by Dr. Crystal Aguh from Johns Hopkins for an AMAZING discussion on central centrifugal scarring alopecia. From uber practical, cheap, safe, effective treatment approaches to deep science on what is happening in this disease, listen this week and you'll be an expert - how to talk to these patients, the baseline treatments everybody should be on, when to get more aggressive, when to step therapy back - the whole enchilada. We even throw in a little frontal fibrosing alopecia. Quite honestly one of the best episodes we've ever done. The Derms on Drugs learned new approaches to this disease and we promise, you will too!

You don't see a lot of kids with psoriasis, but when you do it can be a big challenge, especially if it's bad and they need a systemic. The Derms on Drugs are coming to the rescue! We'll have a special guest - Dr. Doug Kress (who was heavily involved in training all three of the Derms on Drugs) who has enormous experience treating pediatric psoriasis. We'll get into all the stuff you really need to know:-What systemic drugs are approved for psoriasis under the age of 18?-What does the data say about which ones work the best?-How good is Tremfya, the first IL-23 inhibitor approved in kids, and where will it fit?-How is psoriasis in kids different from psoriasis in adults?-What are the roles of the different topicals approved for psoriasis in kids?-How do we think about therapy selection differently in kids vs adults?-Do kids get psoriatic arthritis?-What about shots vs pills in kids?-How do you talk to parents about the different biologics for kids?-How do you handle vaccines in kids who are psoriasis biologics?-Do you ever use methotrexate in kids?

Join the Derms on Drugs and Dr. Shanthi Narla as we dive into the world of obesity, GLP-1s and dermatology. Whatever you think about all of these topics, we promise that your patients are hearing about them, reading about them and will be asking about them. Specifically, we'll get into the latest data about how GLP-1s affect diseases like psoriasis, hidradenitis suppurativa and atopic dermatitis and we'll even touch on if dermatologists should be prescribing GLP-1s. So, while there aren't any definite answers out there yet, tune in this week and you'll be ready when these hot topics come up!