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Dermasphere Podcast Dermasphere is a podcast by dermatologists, for dermatologists, that delivers the latest dermatology research direct to your ears.

Happy Monday! Episode 160 dropped today 🎧In this episode, we are excited to have special guest Dr. Steve Feldman return ...
24/06/2025

Happy Monday! Episode 160 dropped today 🎧

In this episode, we are excited to have special guest Dr. Steve Feldman return again to discuss Loss Aversion. We also discuss facial discoid dermatosis, de-roofing vs excision in HS (& cost), as well as a Clip Show from Episodes 151-159! We hope you enjoy this episode. Listen where ever you get your podcasts!

Learn more about the U of U Dermatology ECHO model! https://physicians.utah.edu/echo/dermatology-primarycare
Learn more about Dr. Feldman here: https://school.wakehealth.edu/faculty/f/steven-r-feldman

And now it's time for Michelle's from Episode 159! What was your favorite topic discussed in this episode?➡IgG4-relate...
21/06/2025

And now it's time for Michelle's from Episode 159! What was your favorite topic discussed in this episode?

➡IgG4-related disease is a rare, systemic disorder involving CD19+ B cells, featuring tumefactive lesions, storiform fibrosis, and IgG4+ plasma cells in the skin and multiple organs.
➡IgG4-RD is linked to fibrotic conditions like autoimmune pancreatitis, Mikulicz disease, Riedel’s thyroiditis, interstitial pneumonitis, and pachymeningitis.
➡Skin manifestations of IgG4-RD, “PLASMA PUPI”: papules, lymphadenopathy, angiolymphoid hyperplasia, subcutaneous nodules, maculopapular eruptions, alopecia, purpura, urticarial vasculitis, psoriasis, ischemic digits
➡Glucocorticoids are first-line for IgG4-RD but not ideal long-term; rituximab induces remission by depleting CD20+ B cells but misses CD19+ plasmablasts that drive disease.
➡Inebilizumab targets CD19+ plasmablasts in IgG4-RD. It acts within 3–5 days, allows for lower steroid use, and leads to more flare-free complete remissions (OR: 4.68).

Listen to this episode wherever you get your podcasts and stay tuned

It's time for Luke's from Episode 159! For our new listeners, each episode the docs compile their Top 5 Clinical Pearl...
20/06/2025

It's time for Luke's from Episode 159! For our new listeners, each episode the docs compile their Top 5 Clinical Pearls to summarize the some of the topics discussed.

➡Lipedema has 5 distribution patterns: pelvis/buttocks/hips; buttocks to knees; buttocks to ankles; arms; and lower legs. Feet are always spared.
➡Stage 1 lipedema: soft subcutis with small nodules and smooth skin. Stage 2: larger nodules, fibrotic tissue, uneven texture. Stage 3: thickened, hardened subcutis with large, disfiguring nodules.
➡Stemmer’s sign (positive in lymphedema): inability to pinch a skin fold at the base of the second toe.
➡Lipedema management includes conservative decongestive therapy (massage, exercise), comorbidity treatment, and liposuction.
➡Extensive port-wine stains covering ≥10% BSA and involving the trunk should prompt blood pressure screening in children.

Extra: GNAQ and GNA11 mutations are linked to capillary malformations; these genes influence calcium signaling, angiogenesis, and possibly the adrenal aldosterone response.

Have you listened to the newest episode of Dermasphere yet? In episode 159, we were joined by Dr. Jacob Scott to discuss...
20/06/2025

Have you listened to the newest episode of Dermasphere yet? In episode 159, we were joined by Dr. Jacob Scott to discuss radiation for skin cancer. We also discussed Lipedema, Inebilizumab for IgG4 disease, and HTN & PWS. What was your favorite part? Listen wherever you get your podcasts 🎧

And now for Michelle's Top Five from Episode 158!1️⃣Patients prone to hyperpigmentation may mistake post-treatment pigme...
06/06/2025

And now for Michelle's Top Five from Episode 158!

1️⃣Patients prone to hyperpigmentation may mistake post-treatment pigment changes as treatment failure and stop effective therapy.
2️⃣Acquired cases of hypertrichosis should be considered in anterior cervical hypertrichosis and can result from localized trauma, chronic inflammation, cutaneous hyperemia, or medications.
3️⃣Anterior cervical hypertrichosis treatment includes temporary hair removal options like shaving or waxing, or permanent ones like laser or electrolysis.
4️⃣It's important to assess family history in anterior cervical hypertrichosis and examine for potential associated findings, such as neuropathy, tailoring treatment to the individual patient.
5️⃣Melanocytomas, which usually occur in optic tissue or meninges, are darkly pigmented with closely packed cells, sometimes requiring melanin bleaching for accurate cytologic assessment.

Check out Luke's Top Five from Episode 158!1️⃣ Port wine stains (+ Sturge-Weber Syndrome) and congenital hemangiomas bot...
04/06/2025

Check out Luke's Top Five from Episode 158!

1️⃣ Port wine stains (+ Sturge-Weber Syndrome) and congenital hemangiomas both stem from mutations in GNAQ or GNA11, but at different codons.

2️⃣Codon 209 mutations (in congenital hemangiomas) cause full GTPase inactivation, while codon 183 mutations (in port-wine stains) cause only partial loss of GTPase function.

3️⃣GNAQ and GNA11 genes are also implicated in tumors like blue nevi, melanocytomas, uveal and cutaneous melanoma, cherry angiomas, anastomosing hemangiomas, hepatic small vessel neoplasms, and choroidal hemangiomas.

4️⃣SeCVAUS: Segmental vascular anomaly with atrophy, ulceration, and scarring. Sharply demarcated, deep red-purple patches with geographic borders.

5️⃣GLUT1 staining is positive in infantile hemangiomas and is also found in healthy placental tissue.

*️⃣Extra: First-line treatment for significant morphea: methotrexate +/- systemic steroids at initiation, with mycophenolate being second-line.

Have you listened to the newest Episode yet? In Episode 158, we were joined by Dr. Tia Paul to discuss Skin of Color Der...
02/06/2025

Have you listened to the newest Episode yet? In Episode 158, we were joined by Dr. Tia Paul to discuss Skin of Color Dermatological Issues. We also talk about Anterior cervical hypertrichosis, a new vascular anomaly called SeCVAUS, if you can you just observe SCCis, and how early inflammatory morphea can mimic port-wine stains. What was your favorite topic? 🎧

Learn more about Dr. Paul at https://balancedskin.com or on Instagram & Tiktok @.tiapaul!

And now for Michelle's Top Five from Episode 157! 🎧➡Cost is often one of the most significant “side effects” for patient...
22/05/2025

And now for Michelle's Top Five from Episode 157! 🎧

➡Cost is often one of the most significant “side effects” for patients, and clinicians should consider what a patient can realistically access or afford.

➡Compounded medications can make certain therapies more accessible, but insurance coverage may be a barrier as most compounded treatments are not reimbursable.

➡First-line therapy for chronic spontaneous urticaria (CSU): standard dose of a second-generation antihistamine. Doses can be titrated up to 4x daily (maybe even 8x) before progressing to third-line options like omalizumab or dupilumab.

➡High-dose antihistamines should be prescribed with caution in older adults due to the increased risk of sedation and falls. Patients can develop tolerance over time.

➡Women can use the men’s version of topical minoxidil to save on cost, as it has the same formulation; fragrance-free options are preferred.

➡Extra: As of April 18, 2025, dupilumab is FDA-approved for treating CSU in patients 12 and older, joining omalizumab as an injectable option.

It's time for Luke's Top Five from Episode 157!➡Access to affordable treatment options remains a priority in dermatologi...
21/05/2025

It's time for Luke's Top Five from Episode 157!

➡Access to affordable treatment options remains a priority in dermatologic care and can be improved using resources like GoodRx, Noblesville Low-Cost Pharmacy, compounding pharmacies, and Mark Cuban’s Cost Plus Drug Company.

➡Nemolizumab, an IL-31 receptor antagonist, achieves a substantial decrease in IGA score for atopic dermatitis in 37% of patients compared to 25% on topicals or placebo.

➡At week 16, the percentage of patients with AD who achieved an EASI 75 response rate was 43% on nemolizumab, 67% on dupilumab, and 70% on lebrikizumab.

➡Patients over age 19 who are candidates for JAK inhibitors should receive the zoster vaccine prior to initiation.

➡Approved IL-13 inhibitors for AD: dupilumab, tralokinumab, and lebrikizumab. JAK inhibitors such as upadacitinib and abrocitinib are also FDA-approved for AD.

➡Extra: Dupilumab can cause temporary eosinophilia, which typically resolves within six months without intervention.

Listen wherever you get your podcasts 🎧😄

Episode 157 dropped this week! 🎧🎙In this episode, we had the pleasure of speaking with Dr. Jules Lipoff (https://www.jul...
16/05/2025

Episode 157 dropped this week! 🎧🎙
In this episode, we had the pleasure of speaking with Dr. Jules Lipoff (https://www.juleslipoff.com) to discuss cheaper dermatology medications. Also in this episode - Nemolizumab trials for AD, and the antihistamine options for treating CSU!

And now for Michelle's Top Five from Episode 156! Listen wherever you get your podcasts. 🎧➡️Measles has an R0 ("R-naught...
15/05/2025

And now for Michelle's Top Five from Episode 156! Listen wherever you get your podcasts. 🎧

➡️Measles has an R0 ("R-naught") rate of 12-18, meaning 12-18 people are expected to get infected from one infected individual.

➡️Koplik spots are pathognomonic for measles: grains of salt on a red velvet cloth, with the red accentuated around the salt.

➡️CTCL can cause intractable itching, skin infections, disfiguring skin lesions, sleep disturbance, and psychosocial problems.

➡️Mogamulizumab targets chemokine receptor C4 (CCR4), expressed on tumor cells and Tregs. For CTCL: better response rate when compared to Vorinostat (28% vs 5%).

➡️Mogamulizumab causes rash in 24% of patients. Can separate from CTCL rashes by time (2-5 mo after starting drug) and location (head, neck, upper trunk, extremities).

If you haven't listened to Episode 156 yet, here are Luke’s Top Five!➡️For the measles vaccine to be effective there nee...
14/05/2025

If you haven't listened to Episode 156 yet, here are Luke’s Top Five!

➡️For the measles vaccine to be effective there needs to be a vaccination rate of 95% or higher. 1 in 5 children become hospitalized from measles.

➡️Serious complications of measles include pneumonia, encephalitis, and subacute sclerosing panencephalitis. It can also dampen immune response to other infections.

➡️88% of patients who get a rash on mogamulizumab respond to therapy compared to 28% of patients who do not get a rash.

➡️Acquired congenital malalignment of the great toenails: lateral deviation of the nail plates during adolescence (compared to the non-acquired version, which begins in infancy).

➡️Hypotheses for causes of congenital malalignment of the great toenails: lateral rotation of the nail matrix, ligamentous abnormality, environmental causes, desynchronization in growth between the nail and the distal phalanx.

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