Dermasphere Podcast (2025)

23/10/2025

It's time for Top Five's from Episode 168! First up, Luke! 👨‍⚕️ For new listeners, our Top Five segment consists of each doc's clinical pearls from the articles discussed in that episode 🤓

➡Cidofovir is a deoxycytidine monophosphate analogue that inhibits viral DNA synthesis and binds 35-40 x more avidly to viral vs. human DNA polymerases.
➡Intralesional cidofovir can be given for recalcitrant warts; IV formulation is commonly diluted for IL use (often ~15 mg/mL) and injected into lesions using serial puncture or cross-hatching techniques.
➡IL or topical cidofovir demonstrates ~50% response in case reports for common, plantar, periungual, flat, and ge***al warts. Response is often seen between 1-3 months.
➡Cidofovir can be used for acyclovir-resistant HSV because it does not require viral thymidine kinase activation unlike acyclovir/valacyclovir.
➡Cidofovir may have antineoplastic and antiproliferative effects, making it a potential option for HPV-induced SCCs, BCCs, HSIL, CIN, erythroplasia of Queyrat, lentigo maligna, and EBV-related nasopharyngeal carcinoma.

17/10/2025

A new episode dropped this week! Have you listened yet?

In this episode, we were joined again by Dr. Ian Myles (who last joined us in Episode 124!) to discuss topical steroid withdrawal. The other topics discussed were chemowraps and cidofovir in dermatology!

Listen wherever you get your podcasts (Apple Podcasts, Spotify, Amazon music, & more!) 🎧

16/10/2025

Now for Michelle's Top Five from Episode 167!

➡Scalp dysesthesia: potential causes include cervical spine disease, cranial nerve impingement, dermatomyositis, autoimmune or inflammatory alopecia, and occasionally delusional parasitosis.
➡Lichen sclerosus (LS) is a chronic inflammatory dermatosis that primarily affects the anoge***al region in postmenopausal women and prepubertal girls. Extrage***al LS occurs in ~15% of cases, often presenting with pruritus or treatment resistance.
➡A review of extrage***al LS showed topical corticosteroids were the most effective first-line therapy: ~80% complete response.
➡Patients with extrage***al LS should receive a full-skin and ge***al exam, as asymptomatic or unrecognized ge***al disease is common and may be mistaken for menopausal changes.
➡Sites of extrage***al LS: upper back > breasts > abdominal folds. Lesions appear as porcelain-white plaques with pruritus and color change. It is important to rule out morphea and overlapping presentations.

In addition to Michelle's Top Five, we wanted to include Dr. Shreya Sreekantaswamy's Top 3!

1️⃣-methionine is an essential amino acid obtained solely through diet, vital for protein synthesis, liver function, and antioxidant activity.
2️⃣Possible mechanisms for L-methionine in wart therapy include oxidation of intracellular methionine, increasing protein susceptibility to proteolytic degradation, or altering keratin composition and its precursors.
3️⃣In a retrospective review of 29 patients treated with Versulisin verulise methionine for verrucae vulgaris, 56% achieved complete or near-complete resolution, while 44% did not respond. All patients with verrucae plana failed treatment.

15/10/2025

Check out Luke's Top Five from Episode 167!

➡In a study evaluating neck stretches for treatment of scalp dysesthesia, 4 of 16 patients achieved complete resolution, 10 partial improvement, and 2 had no benefit. Despite 24% adherence of participants, mean itch severity (VAS) improved from 6.4 to 2.4.
➡A multicenter review of 203 pediatric androgenetic alopecia cases found a mean onset age of presentation of 13 yo, highlighting that early-onset AGA is not uncommon and often managed with topical minoxidil as first-line therapy.
➡Androgenetic alopecia eventually affects approximately 80% of men and 40% of women; 20–30% of females with PCOS also experience androgen-related hair loss.
➡In adults, androgenetic alopecia presenting before age 35 has been associated with increased risk of early-onset cardiovascular disease, insulin resistance, and metabolic syndrome.
➡In women with suspected hormonal abnormalities contributing to acne, mid-cycle total testosterone and DHEA-S are appropriate initial screening tests.

We also loved this quote from Dr. Steve Feldman: “If we can keep in mind that our worst days are better than the best days of most of the people who have ever lived, perhaps we can force our conscious minds to see past the hedonic treadmill and find continuous joy in the lives we lead.”

05/10/2025

If you haven't listened to the newest episode yet, here are the topics we discussed!

-Dr. Feldman joined yet again to discuss the next chapter of his book - The Hedonic Treadmill
-Dr. Sreekantaswamy joined us to discuss L-methionine for warts!
-We also reviewed literature about neck stretches for scalp dysesthesia, extrage***al lichen sclerosus, and pediatric androgenetic alopecia.

What was your favorite part of this episode?

28/09/2025

And now for Michelle's !

1. Pediatric atopic dermatitis carries a significant neuropsychiatric burden with common behavioral comorbidities and frequent sleep disruption. This impact remains underrecognized and undertreated.

2. A retrospective analysis found dupilumab reduced neuropsychiatric risk in pediatric atopic dermatitis: overall 44% risk reduction (RR 0.56); behavioral disorders reduced by 38% (RR 0.62); anxiety disorders by 33% (RR 0.67); and learning disabilities by 59% (RR 0.41).

3. Dupilumab may reduce neuroinflammation through IL-4 and IL-13 blockade as their receptors are present in the brain. This may improve neuropsychiatric, sleep, and behavioral symptoms, possibly also stabilizing the blood–brain barrier by reducing systemic inflammation.

4. Dermatofibromas are benign fibrohistiocytic dermal tumors, typically presenting as hyperpigmented nodules or papules. Solitary lesions are incidental, but multiple (>5) should prompt evaluation for systemic associations (lupus erythematosus, immunosuppression, HIV...).

5. Histopathology of DF: Benign fibroblastic proliferation in the dermis with storiform architecture, collagen trapping, and Factor XIIIa positivity.

We also wanted to incude some key takeaways from Dr. Feldman's guest segment!
➡Belief bias: Anecdotes that align with what people already believe can be especially persuasive, while logical arguments that conflict with those beliefs are often discounted.

➡Clinical relevance: We should remain mindful of belief bias in both our patients and ourselves, using careful language that respects perspectives and helps preserve patient autonomy.

28/09/2025

If you haven't listened to Episode 166 yet, here are Luke's !

1. Belief bias explains why a compelling story, especially one with a believable conclusion, sometimes sways people more than data. Narratives can influence decision-making even when objective evidence is available.

2. Infantile hemangiomas with suboptimal response to standard propranolol were often segmental, located in the head/neck, and had deep or mixed components.

3. The incidence of IH is about 1.64 per 100 person years with an increasing trend over the last three decades. 12% of these infantile hemangiomas are high risk and require treatment consideration.

4. First-line dosing for IH is propranolol 2 mg/kg/day, often BID. It works 95% of the time.

5. Plausible mechanisms for propranolol’s effect include vasoconstriction, inhibition of angiogenesis, induction of endothelial cell apoptosis, increased pericyte contractility, and modulation of adipogenesis/hemangioma stem cell differentiation.

21/09/2025

Episode 166 dropped last week! Have you listened? If not, here are the topics that were discussed in the episode! 🎧

➡Dr. Steve Feldman on BELIEF BIAS
➡Dupilumab and improved neuropsychiatric diagnoses
➡Hemangiomas that don't respond to propranolol
➡Multiple DF associations

14/09/2025

And now for Michelle's Top Five from Episode 165!🎧

➡Chronic hand eczema is challenging to manage because hands are constantly exposed to irritants and mechanical stress, and treatment must also be tailored to multiple subtypes.

➡A CASCADE trial showed that once-daily full-body emollient use in a community-based population, not selected for risk, reduced atopic dermatitis incidence by 16% at 24 months (NNT=15).

➡L-carnitine is essential for mitochondrial fatty acid transport; deficiency causes fatigue, weakness, and fat accumulation. This overlaps with side effects of myalgias and weakness seen with isotretinoin treatment in cystic acne.

➡A study reported that isotretinoin reduced serum carnitine levels and increased urinary excretion; carnitine supplementation improved MSK symptoms in affected patients and allowed for continuation of therapy.

➡Recommended carnitine supplementation is typically 500 mg TID (1500–2000 mg/day). Doses >3 g/day can cause a fishy odor in sweat, urine, and breath.

14/09/2025

Check out Luke's Top Five from Episode 165! 🎧

➡Chronic hand eczema includes the subtypes: atopic dermatitis, allergic contact dermatitis, hyperkeratotic eczema, irritant contact dermatitis, and vesicular/dyshidrotic eczema.

➡Delgocitinib, the first topical pan–JAK inhibitor, was FDA-approved in July 2025 for chronic hand eczema. In an RCT of topical steroid-refractory patients, treatment success (IGA-CHE 0–1 at 16 weeks) was achieved in 25% on delgocitinib vs 9% on placebo.

➡Retinoids reduce scaling and are effective for some ichthyosis phenotypes (lamellar, PPK) but should be avoided in others such as Netherton syndrome. Retinoids are not a permanent solution, and symptoms recur after discontinuation.

➡Acitretin can persist in your system for up to 3 years due to its conversion to etretinate, which accumulates and gets stored in fat. Use caution in patients of childbearing potential.

➡Long-term, retinoids may cause skeletal toxicities, including premature epiphyseal closure, tendon/ligament calcifications, osteophytes, DISH (diffuse idiopathic skeletal hyperostosis), and altered bone density.

13/09/2025

If you haven't listened to Episode 165 yet, here are the topics that were discussed! We were once again thrilled to have Dr. Feldman as our special guest on this episode! 🎧

➡Delgocitinib cream for hand eczema
➡Dr. Feldman on MEANING
➡Systemic retinoids for ichthyoses
➡Prevent AD by greasing up your baby
➡Carnitine for isotretinoin-induced myalgias

09/09/2025

And now for Michelle's Top Five!

➡N-acetylcysteine (NAC) is a precursor of cysteine and glutathione used in acetaminophen toxicity and decreasing impulsivity, cravings, and compulsive behaviors through effects on the cysteine-glutamate exchange system.
➡73% of pediatric patients with behavioral issues such as hair pulling, nail biting, or cutaneous habits improved with NAC, and none worsened, with a mean treatment duration of 30 months.
➡Pyogenic granulomas are common, benign, rapidly growing vascular neoplasms usually of skin or mucous membranes, most commonly found in children and adolescents.
➡Imiquimod was effective for pediatric pyogenic granulomas, including infants as young as 4 weeks, with no systemic complications, making it a cost-effective, noninvasive therapy that reduces hospital and clinic visits.
➡Extramedullary plasmacytomas are monoclonal plasma cell tumors outside bone that can rarely develop in the skin after trauma and are often associated with multiple myeloma.

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