Dermasphere is a podcast by dermatologists, for dermatologists, that delivers the latest dermatology research direct to your ears.
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Hello, friends & colleagues! We have VERY exciting news in the Dermasphere!
Our very own, Dr. Michelle Tarbox, was just named Chair of the Department of Dermatology at Texas Tech University Health Sciences Center! ❤️🖤
Join us by congratulating Dr. Tarbox on this incredible accomplishment. 👏🏻👏🏻👏🏻👏🏻
Episode 136 is out now!
In this episode, we discuss Demodex mites and how they are on your face... frequently. We also go over updates from the Society of Pediatric Dermatology (SPD) 2024 Annual Meeting. Lastly, we discuss emergency contraception for Isotretinoin.
What is your favorite part of the episode? Leave some questions or comments below!
Listen on Spotify or Apple Music 🎧
If you haven't yet listened to Episode 135, here are Dr. Tarbox's !
➡Intradermal (ID) vs intramuscular (IM) injection of botox: duration and anti-wrinkle effect was the same. Intradermal injection rated almost 2x more painful.
➡IM injection group had a lowered brow position after 2-4 weeks, whereas the brow position in the ID injection group was preserved.
➡Resistant eleven lines after injecting corrugators and procerus? Consider injecting the supercilii, a muscle that inserts along the medial orbital rim inferior to the corrugators.
➡Method for ID injection: double hydrate the botox with 4 ccs normal saline (rather than boxed suggestion of 2.5 cc) and bend the needle bevel up.
➡Fellow Dermatopathologists: check out the most recent Appropriate use criteria for ancillary testing! DOI: 10.1111/cup.14135.
Check out Dr. Johnson's from Episode 135!
➡Patients are more likely to believe or follow through with something if they come up with it themselves (e.g., motivational interviewing).
➡Perceived time has a measurable effect on wound healing beyond the actual passage of time(!). Less perceived time passed = less wound healing, and vice versa.
➡Spironolactone for acne: 6 wks at 50 mg, increased to 100 mg. IGA noted improvement on wk 12, QoL improved at wk 24.
➡Common side effect of spironolactone is headache. Other side effects (dizziness and menstrual irregularities) are more common in doses higher than 100mg.
➡In a clinical trial, spironolactone was found effective regardless of patient characteristics (acne severity, BMI, PCOS, ethnicity, topicals, OCPs).
Have you listened to Episode 135 yet? If not, here are the topics that were discussed in this episode! 🎧
For the third episode in a row, we are delighted to be joined by Dr. Feldman to discuss "Resistance to Others' Ideas"!
Other topics discussed in this episode include:
-Mind over matter over wound healing
-Intradermal Botox: Just as good or possibly better!
-Spironolactone works!...but not until 6 months
-Appropriate use criteria for dermpath studies
Comment your favorite part of the Episode below!
I'm excited to share a fun interview I recently did on the podcast. Hope you enjoy it! -Dr. Johnson
https://www.learnskin.com/podcasts
Here's Dr. Tarbox's from Episode 134! Have you listened yet? 🎧
➡Erenumab is an anti-CGRP receptor antibody approved for migraines, but may help with rosacea.
➡Erenumab reduced moderate/extreme flushing by a mean of 7 days, and reduced moderate/severe erythema by a mean of 8 days. Patients with severe disease did the best.
➡Current treatments for erythrotelangiectatic rosacea: brimonidine, OTC oxymetazoline in moisturizer, acetazolamide, compounded oxymetazoline 1.2% cream, lasers.
➡Vismodegib and sonidegib, by inhibiting the intracellular hedgehog pathway, treat severe basal cell carcinoma.
➡>20% patients discontinue vismodegib due to AEs like muscle cramps, GI distress, dysgeusia and fatigue. Lower doses of vismodegib + itraconazole improves tolerability.
Happy 4th of July!
Check out Dr. Johnson's from Episode 134!
➡Humans present 2 approaches to authority: resistance (e.g., don’t do the treatment) and total submission. Consider this in interactions and treatment plans.
➡Cutis marmorata telangiectatica congenita (CMTC) is a generally benign reticular birthmark of the neurovasculature, often on an extremity. It improves over time.
➡Retinal involvement with CMTC: lacy peripheral capillary anomalies with prominent terminal vascular bulbs. Get baseline exam with ophthalmology.
➡A genetic mutation in NOTCH1 causes Adams-Oliver Syndrome. Presents with CMTC, limb defects, cleft lip/palate, mottled skin, FTT, CNS malformations, developmental delay.
➡Pott's puffy tumor: an abscess of the periosteum from osteomyelitis of the frontal bone, usually from trauma or sinusitis. Get CT imaging, or MRI to assess CNS infiltration.
If you haven't yet listened to Episode 134, here are the topics we discussed!
-Dr. Feldman on Submission & Resistance to Authority
-Erenumab for rosacea
-CMTC and eye stuff
-Vismodegib + itraconazole FTW
-Don't go poking puffy Pott's
Available to listen wherever you get your podcasts. 🎧
Check out Dr. Tarbox's from Episode 133!
➡Chronic idiopathic pruritus is a diagnosis of exclusion. Look for causes first: CBC, ESR, CRP, creatine, glucose, LFTs, thyroid panel.
➡Itch may lie on an up-regulated continuum of sensation. At one end is the sensation of touch and at the other end is pain.
➡C- fibers are unmyelinated and carry pain, itch, and hot/cold. We can utilize other sensations to override itch (e.g., ice packs, vibration devices).
➡Psychiatric conditions have a high comorbidity of itch. In schizophrenic patients, 32% have chronic pruritus.
➡Psychogenic medications for chronic pruritus: SSRIs, SNRIs, atypical antidepressants, antipsychotics, naltrexone, butorphanol, nalfurafine, anticonvulsants.
Have you listened to Episode 133 yet? If not, check out Dr. Johnson's
1️⃣ The curse of knowledge: what might be common knowledge to use as physicians, may not be something our patients know. Communicate thoroughly.
2️⃣ In a French database from 1995 and 2007, minocycline had 4x reported ADRs compared to doxycycline despite having 2/3 sales numbers.
3️⃣ Doxycycline ADRs include GI distress, esophagitis and photosensitivity. Pill esophagitis less likely when using the monohydrate formulation of doxycycline.
4️⃣ Minocycline ADRs: pigment disorders, intracranial hypertension, hepatic disorders, lupus syndrome, DRESS and pulmonary disorders.
5️⃣ Anifrolumab, an IFNAR1 antagonist, is a monthly IV medication FDA approved for systemic lupus and found to help cutaneous manifestations of juvenile dermatomyositis.
Episode 133 is out! Check out the topics discussed by Dr. Tarbox and Dr. Johnson below. What was your favorite topic discussed? 🎧
➡ Dr. Feldman on The Curse of Knowledge
➡ Doxycycline is better than Minocycline
➡ Psychoactive meds in pruritus
➡ Anifrolumab for cutaneous JDM
Here are Dr. Tarbox's from Episode 132!
1️⃣Patients on dupilumab for AD have an OR of 4 for developing CTCL; NNH=738. Excluding DMARD use, OR=3.2 and NNH=833.
2️⃣Treatment of AD with dupilumab lowered the risk of BCC (OR=0.4) and melanoma (OR=0.5).
3️⃣Severe chronic AD is a predisposing factor for CTCL. Especially in older patients, exclude CTCL before starting dupilumab.
4️⃣Hemophagocytic lymphocytosis is caused by an inappropriate activation of CD8+ T cells and NK cells leading to spleen, liver, and bone marrow damage.
5️⃣Subtypes of calcinosis cutis: dystrophic (autoimmune disease, cancers), metastatic (chronic renal failure, hyperPTH, too much vit D), iatrogenic (medications), idiopathic.
Check out Dr. Johnson's from Episode 132! Have you listened yet?
1️⃣CTCL likes to affect “double-covered" areas like the buttocks and groin.
2️⃣Chronic spontaneous urticaria treatment: first-line is 2nd generation H1 blockers (4x normal dose), second-line is omalizumab, third-line is cyclosporine.
3️⃣Labwork for chronic spontaneous urticaria: CBC, ESR or CRP, anti-TPO antibodies, total IgE, tryptase.
4️⃣BTK inhibitors look good for chronic spontaneous urticaria. They function by preventing mast cell degranulation.
5️⃣Petroleum jelly blocks 50-99% of transepidermal water loss, accelerates barrier repair, increases stratum corneum thickness, increases barrier proteins, and is non-comedogenic.
Episode 132 is out, have you listened yet? In this episode, we discuss the following topics:
➡ Dupilumab and CTCL... it's complicated.
↪️Dupilumab and lymphoid reactions
↪️Dupilumab worsens CTCL
➡ Updates in CSU pathophys and treatment
➡ Calcinosis cutis options
➡ Petroleum Jelly: it's awesome, and here's why...
Comment below your favorite topic discussed! 🎧
Have you listened to Episode 131 yet? If not, here are Dr. Tarbox's !
-Hair straightening treatments with glyoxylic acid can absorb systemically through the scalp, turn into oxalate, and cause acute kidney injury.
-Mice treated with glyoxylic cream: urinalysis showed elongated calcium oxalate monohydrate crystals (similar to ethylene glycol poisoning).
-Safe hair straightening treatments: straight perms with sodium thioglycolate, hair straightening devices with tourmaline metal, protective hairstyles (less tension).
-DaxibotulinumtoxinA (Daxxify): 150 kDa of botox A + proprietary stabilizing excipient peptide RTPOO4 (instead of human serum albumin) = long lasting formulation.
-Morgellons disease management: always look for the cause of the pruritus, mitigate it if possible, keep an open mind to the idea of an unusual infectious presentation.
If you haven't yet listened to Episode 131, here are Dr. Johnson's !
-It is more cost effective to apply heavy sunscreen (vs "routine use").
-Trametinib + dabrafenib is more effective for treating advanced melanoma than vemurafenib monotherapy, but is much more expensive.
-Using thin oils (mineral oil, vaseline oil, glycerin) + phototherapy allows better UV pe*******on. Thick products (petrolatum, salicylic acid) worsen UV pe*******on.
-96910 is the CPT code to use when adding an emollient to phototherapy. (Also, it reimburses more!)
-Phototherapy decreases epidermal hyperproliferation and reduces immune response, angiogenesis, DNA/RNA/protein synthesis, and Langerhans cells.
Have you listened to Episode 131 yet? In this episode, Dr. Tarbox and Dr. Johnson discussed the following:
-Hair straighteners cause AKI
-Cost-effectiveness: Important!
-Daxibotulinum toxin: It's like DOUBLE BOTOX!!!
-Emollient + phototherapy = better
-Morgellons disease... is it sometimes Lyme disease?
Listen on Spotify or Apple Music! 🎧
If you haven't had a chance to listen to Episode 129 yet, here are Dr. Johnson's Top FIve points from the articles & topics discussed.
-The strongest risk factor of melanoma in skin/CNS for patients with congenital nevi was abnormal screening MRI of the CNS (12%).
-Early CNS MRI in patients with 2+ congenital nevi (at least one 1.5 cm or larger) should be done within the first 6 months of life.
-90% of atopic dermatitis lesions are colonized with staph, which contains a protein called V8 protease to activate PAR1 receptor neurons causing itch.
-Keratinocytes produce proteases called kallikreins which cleave PAR2 and cause itch. S. aureus induces this process.
-Allokinesis: itch evoked by innocuous mechanical stimuli or touch and is a form of dysesthesia regulated by merkel cells.
If you haven't had a chance to listen to Episode 129 yet, here are Dr. Tarbox's Top 5️⃣!
-The Pigmented Lesion Assay tests for LINK, PRAME and TRT. 28 out of 30 melanomas had LINK or PRAME, 22 out of 30 melanomas had TRT.
-Reexcise (2 mm to 5 mm) severely histologically dysplastic nevi with a positive margin.
-Delusion of parasitosis: most common mono symptomatic hypochondriacal psychosis in dermatology. DSM-5 criteria: delusion for 1 month without meeting schizophrenic criteria.
-Escalating doses of stimulant medications can cause development of delusion of parasitosis.
-Pimozide is one of the only therapeutic drugs for delusion of parasitosis that is not considered an antipsychotic. Can cause EKG abnormalities at higher doses.
Have you listened to the newest Episode yet? In Episode 130, we discussed the following:
-starting a private practice and the Direct Care model with Dr. Stephen Lewellis (Huge thanks to Dr. Lewellis for chatting with us!)
-juvenile gangrenous vasculitis of the sc***um
-midline lesions and when to image
AAAANNNND, there's a Dermasphere clip show from Episodes 121-130!
Listen on Apple Music and Spotify! 🎧
Hello friends and colleagues! Dr. Tarbox is running a CME activity on Prurigo Nodularis that takes place on a digital platform called “Gather-ed.” You can get some (free!) CME/CE credit while completing brief learning modules and collaborating with others within the group. The time commitment is modest and flexible (and will start in a couple weeks!) Hope to see you there! Visit this link to learn more & sign up!
https://horizoncme.gathered.com/invitation?ref=GELe3oAe69
If you haven't had a chance to listen to Episode 128 yet, here were Luke's ! (Technically, 6😁)
-Reduce dermatology's carbon footprint: use clean (not sterile) gloves, use sanitizer (vs soap and water), increase telemedicine, use absorbable sutures (saves the patient return-to-clinic gas).
-Oral niacinamide... if it helps reduce skin cancer risk, the reduction seems to be small.
-A meta-analysis found niacinamide to have a 23% reduction in nonmelanoma skin cancer, but this was not sustained after discontinuation.
-Patients with high niacinamide diets had a slight decrease in SCC and a slight increase in BCC. Dietary recommendation is 15 mg/day.
-From 1990 to 2019, the global age standardized incidence rate of non melanoma skin cancer increased from 54 to 74 per 100,000 people.
-Niacinamide deficiency can cause pellagra: diarrhea, dermatitis, dementia and death. Can occur from GI diseases, alcoholism, malignancy, and medications (isoniazid)
If you haven't listened to Episode 128 from two weeks ago, here are Michelle's !
-Nail clipping for melanonychia: beneficial to determine location of pigmentation and melanocyte remnants, and guide location of biopsy.
-Ddx for nail unit melanoma: pigmented onychomycosis, nail unit melanocytic nevus, subungual lentigines, melanotic macule, subungual hemorrhage, pigmented onychomatricoma, onychocytic matricoma, onychopapilloma, medication-induced melanonychia.
-Follicular keratinocyte upregulation is seen in moderate/severely dysplastic nevi (compared to common nevi).
-Benign melanocytic lesions have a BRAF V600E mutation, which causes a phosphomimetic intracellular transduction molecule that activates serine threonine kinases.
-Mutations that occur in later stage melanoma development: CDKN2A, SWISNF, P10, TP53.
NEW EPISODE ALERT 🎧❗️ Episode 129 is out now!
In this episode, Dr. Tarbox & Dr. Johnson discuss the following:
➡️Melanoma, etc., in CMN
➡️Dysplastic nevi management
➡️Staph -> V8 -> PAR1 -> itch
➡️Delusions of parasitosis
What was your favorite part of the episode? Comment down below!
Hello, friends and colleagues! Luke here. I’m running a CME activity on urticaria that takes place on a digital platform called “Gather-ed.” You can get some (free!) CME/CE credit while completing brief learning modules and collaborating with others within the group. The time commitment is modest and flexible (and will start in a couple weeks). I’ve done this before (for atopic dermatitis and prurigo nodularis); the lessons are well-made, and learners find it a valuable experience.
You can learn more and sign up at: https://aaaai.gathered.com/invitation?ref=4openn7e7A
Hope to see you there!
In today's episode of Dermasphere, we discuss some major breaking news: Archeologists have recently recovered the fabled, mystical fountain of youth! Upon performing NMR spectroscopy on the contents of the fountain, they discovered it contained both Tretinoin and Sunscreen. Swipe to see the photos taken of the groundbreaking discovery.
Happy April Fools!
Have you listened to Episode 127 yet? If not, here are Michelle's from the articles discussed in the episode!
1️⃣500mg of oral propolis for 3 months completely cleared warts in 73% of patients, flat warts in 75% of patients, and plantar warts in 17% of patients.
2️⃣Female patients under 50 with NF-1 have a 5x increase in double/triple negative breast cancer. Get a yearly breast MRI after age 25.
3️⃣Dermoscopy of splinters: pigmented lesion due to hemorrhage, parallel ridge pattern, perhaps fungal hyphae.
4️⃣Acute localized exanthematous pustulosis (ALEP): a systemic drug hypersensitivity reaction commonly presenting in the one site of the face/trunk/upper limbs with itching/burning.
5️⃣Acute generalized exanthematous pustulosis (AGEP) begins in intertriginous areas. Neutrophils in the dermis, increased Il-17 and Il-22.
Hello, listeners! Have you listened to Episode 127 yet? If you haven't, here are Luke's from the articles discussed in this episode.
1️⃣Essential oils to treat molluscum: 56% of patients using lemon myrtle and 84% using tea tree oil saw 90% improvement.
2️⃣Babies up to 11 months old can present with a squishy nodule on the scalp called a delayed subaponeurotic fluid collection. It will spontaneously resolve.
3️⃣Tapinarof, a new psoriasis topical, is associated with folliculitis in 20% of patients and can also cause contact dermatitis.
4️⃣For CV risks with psoriasis: check bp, lipids every 3 years, A1c every 5 years, and counsel patients to stop smoking.
5️⃣Alternatives to benzoyl peroxide: salicylic acid, chlorine dioxide cleanser, aseptic MD, dilute sodium hypochlorite solution, azelaic acid.
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Have you listened to episode 98 yet? If not, here are Luke's #TopTen! . . . 1. Human genital differentiation starts during embryonic development at week 6 and is completed by weeks 12-14. 2.Spironolactone may not cause feminization of a male fetus. 3. Nicotinamide Riboside (NR): variant of vitamin B3 found in milk, yeast, and beer. Used for chemoprophylaxis against keratinocyte carcinoma. 4. NR may indirectly provide energy for cancer cells to proliferate > patients with an active cancer treatment regimen should discuss supplements with their oncologist 5. AD is present in approximately 9.8% of the pediatric population of the United States. 6. TikTok videos about AD: viewers were no more or less "engaged" in videos made by healthcare professionals (vs other videos). 7. Top 120 AD TikTok videos had 10 million views, 10 million likes, and 125,000 comments 8. Calcinosis cutis causes: dystrophic, metastatic, iatrogenic, and idiopathic. Treatment options: topical or IL sodium thiosulfate, CO2 laser, and extracorporeal shockwave lithotripsy. 9. When a referral or pathology report, triage, etc. provides you with a patient diagnosis, critical analysis of your medical decision making and how you arrive there prevents anchoring. 10. Anchoring patient treatment options first with a worse option makes patients more amenable to the original intended option. (e.g., shots 4x/day vs shots every 2 weeks.) . . We are not advanced enough for the TikTok, but this is our best shot (;
SDRIFE from acetaminophen – Eosinophilic fasciitis from drugs – Natural products for AD (part 3) – Cupping and ancient coins – Physician attire Luke and Michelle report no conflicts of interest. http://www.dermaspherepodcast.com/
I#demodexdanceparty
For your Thursday viewing pleasure, we at Dermasphere Podcast are pleased to present the Dance of the Demodex, a time lapse video of confused Demodex mites I liberated from the eyelashes of a patient with chronic demodicosis and recalcitrant blepharitis. What song would you use as a soundtrack? #dancingdemodex
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