Derms on Drugs

The diagnoses get messy, the treatment decisions get interesting, and the DoD crew has opinions. From a major scabies study to a practical overlap-disease pearl, this week's episode is full of reminders that dermatology is rarely as straightforward as it seems.

Melanoma, Anxiety, and Depression Links; Biosimilars vs Humira; Air Pollution and Atopic Dermatitis – Have We Finally Figured Out Why Eczema Is So Common and much, much more… Which patients are the most affected by anxiety and depression after a melanoma diagnosis and what can we do about it?Patients who are switched onto a biosimilar do “worse” than patients who start one as their first therapy – why?We finally got eczema answers. Turns out that air pollution, both indoor and outdoor, is the cause of the atopic dermatitis epidemic that started in the 1970s and is why eczema is more common in urban areas.Ian Myles explains how he proved that air pollution is the driving force behind atopic dermatitis and helps our team understand what it all means Plus: Predictors of acne relapse after isotretinoin, dupilumab prevents cancer, how well does tralokinumab work in dupilumab "failures," ferulic acid for rosacea, cysteamine vs hydroquinone for melasma, and the best way to treat digital mucous cystsGuest: Ian A. Myles, MD, Mph Dr. Myles, Principal Investigator, Epithelial Therapeutics Unit, graduated with a B.S. in biology from Colorado State University in 2001 and then obtained an M.D. from the University of Colorado in 2005. He completed an internal medicine residency at The Ohio State University prior to beginning fellowship training in allergy and clinical immunology at NIH. He worked under the mentorship of Dr. Sandip Datta investigating the mechanistic details of susceptibility to S. aureus skin infections. In 2011, Dr. Myles became a commissioned officer in the United States Public Health Service Commissioned Corps. LCDR Myles has supported several USPHS missions, from the Ebola virus vaccine trial in West Africa to congressional Gold Medal Ceremonies at the U.S. Capitol. In 2013, he was awarded a position as an assistant clinical investigator in the NIAID Transition Program in Clinical Research. Dr. Myles received his M.P.H. from George Washington University in 2016. In 2018, Dr. Myles became the head of the newly formed Epithelial Therapeutics Unit to evaluate the efficacy and safety of a topical, live bacterial treatment for atopic dermatitis (eczema). He is currently a participant in the Lasker Clinical Research Scholars and Distinguished Scholars programs.

This week’s Derms on Drugs is a classic six-pack episode. From cutting-edge CTCL therapies to biologic safety data and the growing world of oral photoprotection, the group covers the studies worth knowing—plus a few opinions spicy enough to start a conference hallway argument.

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.