Elevate-Derm Summer Conference Clinical Insights Day 1

Clinical Insights from the 2nd Annual Elevate-Derm Summer Conference at the Grand Hyatt Deer Valley in Park City, Utah

Day 1: Thursday, July 24, 2025

8:00-9:00 am

From Report to Reality: Understanding Pathology Results: Ata Moshiri, MD

• A pathology report is an opinion or interpretation of a biopsy rather than a statement of fact or
  truth.
• When taking a biopsy, you should mark the lesion, take photos, and include at least two anatomic
  markers and include patient identifiers in order to reduce wrong-site surgery.
• Clinical photos improve dermatopathology diagnosis of lesions and rashes.
• A pathologist is looking at less than 1% of the tissue sent.
• When biopsying a rash, always utilize a punch biopsy (not a shave) and be sure to take the
  sample from the most active area of the rash.

9:00-10:00 am

Contact Dermatitis Conundrums: A Panel Discussion on Challenging Cases: Walter Liszewski, MD, and Kara Mudd, PA-C

• When patch testing, always ask patients what they do for a living and what their hobbies are.
• It is important to educate patients that natural substances can still cause allergic reactions.
• When taking a history for pediatric patients with contact dermatitis, remember to ask about
  exposures at school.
• There are some case reports of vasculitis caused by metal allergies. Think outside the box
  for metal source, for example a Copper intrauterine device contains copper but also contains
  nickel.
• For patients who have HEMA (Hydroxyethyl methacrylate) allergies, dip nails, polish, and
  manicures are safe alternatives to gel polish.
• The loss of cuticles is a common side effect of chronic hand dermatitis.
• PPD and sodium thioglycolate are the only allergies that will involve the scalp.Propylene glycol is highly allergenic. Three topical treatments that do not contain propylene glycol are: Triamcinolone 0.1% ointments, Tacrolimus 0.1% ointment, and Roflumilast 0.15% or 0.3% cream.

10:45 am-11:15 am

Atypical Nevi: A Dermatopathologist’s Guide to Patient Conversations: Ata Moshiri, MD

• Because of the controversy surrounding the term "dysplastic nevus,” it seems appropriate to
  discontinue use of that diagnosis and describe these lesions as "nevus with architectural
  disorder" with a statement as to the presence and degree of melanocytic atypia (mild,
  moderate, or severe).
• A higher genetic incidence of the BRAF mutation and a lower incidence of the CDKN2A tumor suppressor make atypical nevi (precursor lesions) more likely to develop into malignant melanoma.
• There is still an approximate 10% chance that an atypical nevus is still present, even if
  margins are clear with biopsy,
• Atypical nevi serve as dose-dependent risk markers for a potential melanoma in that patient.
• All biopsy sites (of common nevi and atypical nevi with positive or clear histologic margins)
  need to be monitored for unusual growth and rebiopsied if this occurs. Patients should be
  educated about examining scars for warning signs of melanoma and when to notify the
  clinician for reevaluation.
  
  

11:15 -11:45 am 

Literature Review: Key Insights & Emerging Trends: Eileen Cheever, PA-C

• It is important to emphasize strict adherence to contraceptive methods in patients with
  previous infertility due to metabolic syndrome, that are on both GLP-RAs and isotretinoin since
  correction of metabolic syndrome and slowed gastric emptying increases risk of pregnancy.
• The proportion of people over the age of 65 is expanding, so it is important to be aware of the
  principles in geriatric dermatology care. There is a need to individualize care, to share
  decision making, to consider socioeconomic needs, and to have a holistic approach to
  healthcare.
• Povorcitinib is being studied for adults with moderate-severe hidradenitis suppurativa.
• Patients on certain antihypertensive medications are potentially more susceptible to actinic keratosis and should have proactive dermatology management (skin exams).
• Pinto beans were used to treat warts by taping a dry pinto bean to each wart overnight for 1-2
  weeks and showed results similar to other wart treatment modalities.
• Studies have shown that people use more sunscreen when it is at no cost to them, so it is
  important to consider sunscreen recommendations and emphasize the importance of broad
  spectrum sun protective habits to our patients.

12:30-1:30 pm

Patch Testing Demystified: Distinguishing Positives from False Positives and Ensuring Relevance: Walter Liszewski, MD and Kara Mudd, PA-C

• Patch testing basics include scheduling appointments for Monday, Wednesday, and Friday,
  ensuring appropriate chamber filling and reading results at 96 hours. The use of antihistamines is okay, but avoid corticosteroids, IL-4, IL-13 inhibitors, JAK inhibitors, and other systemic immunosuppressants used in atopic dermatitis.
• When applying a patch test, avoid placement on the patient’s spine due to the risk of movement.
• For a patch test to be positive, it needs erythema with induration. If there is no induration, then allergy is unlikely.
• Metals (especially gold) often take longer to show an allergic reaction, so be sure to follow up at the 96-hour mark in addition to the 48-hour mark.
• CAMP is a Contact Allergen Management App that is available to members of the American
  Contact Dermatitis Society. Once a provider has access to CAMP, they can use it to help
  patients understand their allergens.
• Gold allergy will often cause an allergic reaction in areas other than where the gold is used.
• For example, a gold ring can lead to an allergic reaction on the eyelids.
• Do not allergy test children to paraphenylenediamine (PPD), as they are easily sensitized. If it is
  included in the patch test, remove it by cutting out the square before applying it to pediatric patients.

1:30-2:30 pm

Melanonychia: When to Biopsy and how to Decide: Ata Moshiri, MD

• Non-melanin-derived pigmentation in the nail can be due to: exogenous pigmentation (tobacco), subungual hematoma, fungal melanonychia, and bacterial melanonychia.
• A nail unit melanocytic nevus in children can involve the skin in the nail fold (pseudo-Hutchinson’s sign), and it is benign, but a biopsy is still necessary to rule out melanoma.
• Physiological causes of melanocytic activation (melanotic macule) are ethnic melanonychia and pregnancy.
• You should biopsy melanonychia if it is monodactylous, is located in the thumb or hallux, is a
  thick band greater than 3 mm, is changing over time, is irregular in width (triangle sign), is multicolored, the pigment extends onto the cuticle/nail fold, and/or there is nail dystrophy/destruction.
• A nail matrix biopsy with full-thickness excision is indicated for a nail with a high likelihood of
  melanoma, including wide bands.
• Nail clippings can be utilized if a patient with concerning pigment in the nail is resistant to a nail matrix biopsy. If melanocytic remnants are present in the clipping, this is a very concerning finding for melanoma.

3:15-4:15 pm

Mucosal Dermatology: Oral and Genital Cases: Walter Liszewski, MD

• Dentists receive very little training in oral disease and do not receive training in oral biopsies.
• Dermatology providers are clear to biopsy cheeks and lips, but ear/nose/throat, or oral surgery providers should do all other oral biopsies.
• Triamcinolone dental paste is not a good topical for oral lesions due to its texture and taste.
• Consider Clobetasol or Flucinonide instead.
• Vitamin B supplements can help prevent recurrent aphthous ulcers.
• A patient with lichen planus needs to be evaluated by an ENT yearly for oral cancer screening.
• You should always examine the genital area in psoriasis and hidradenitis suppurativa patients.
• In male patients, treat lichen sclerosis with clobetasol. Explain that hygiene is very important.
• Circumcision can be done in refractory cases. Do not forget to ask about urethral stenosis.
• If a patient with genital warts has not been vaccinated for Human Papillomavirus,
• recommend that they get vaccinated. Encourage patients with anal warts to see a colorectal surgeon for anal Pap smears.

4:30-5:00 pm

JAK Inhibitors: Practical Tips for Integration into Practice: Walter Liszewski,  MD

• Use caution in prescribing Janus Kinase Inhibitors in patients with any of the following conditions: a history of blood clots, over the age of fifty, a history of malignancy, a history of renal and liver disease, or women of childbearing potential.
• There are four Janus Kinases: JAK1, JAK2, JAK3, and TYK2.
• Janus Kinase inhibitors are indicated for alopecia areata patients with a SALT score of at least 50.
• Consider using a Janus Kinase Inhibitor in a patient with moderate to severe atopic dermatitis who failed at least one systemic agent, is systemic naive but has severe itch, or is systemic naive but has both allergic contact dermatitis and atopic dermatitis.

5:00-5:30 pm

Chronic Urticaria: Unveiling the Next Major Frontier in Dermatology: Walter Liszewski, MD

• The pathophysiology of urticaria involves the release of histamine made by mast cells and basophils, which causes vasodilation. Then, the other immune cells are activated and recruited (lymphocytes and eosinophils).
• Acute urticaria is hives that last for six weeks or less. Chronic urticaria is hives that last daily or almost daily for at least six weeks.
• In patients with chronic spontaneous urticaria, consider the following labs: Hepatitis B and C,  Helicobacter pylori, CBC, CMP, TSH, and total IgE.
• Patients with cold urticaria should be counseled to never swim alone.
• Over one-third of chronic spontaneous urticaria patients experience angioedema.
• Fexofenadine is best absorbed on an empty stomach.