Elevate-Derm Summer Conference Clinical Insights Day 2

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

Day 2: Friday, July 25, 2025

7:30-8:30 am

Pediatric Dermatology in Focus: Kodachrome Case Studies: Jim Treat, MD

• For infants who have dermatitis and clinically appear to have skin infections, be sure to check the 
  lymph nodes. A lack of lymph nodes upon palpation can be a sign of immunodeficiency.
• Candida in a nail or multiple nails in a child can be a sign of immunodeficiency. Refer for
  genetic testing.
• Clinical scenarios that suggest immunodeficiency are recalcitrant infections or exuberant
  infections.
• The average duration of molluscum is 18 months. If a child comes in with molluscum
  If a condition has been present for 3 or 4 years, or if they have an unusually high number of molluscum or warts, 
  they need to see an immunologist.
• Acute Generalized Exanthematous Pustulosis (AGEP) in pediatric patients is characterized
  by: fever, pustules, malaise, is self-limited (1-2 weeks), and the pustules resolve with peeling.
  AGEP is often triggered by antibiotic use.
• If someone has a TH1 disease and a strong family history of autoimmune disease, use caution
  before giving them a TH2-suppressing medication since it can upregulate their TH1 response.
• Some birthmarks can now be treated with topical medications if the mutation can be identified.
  For example, topical sirolimus therapy can be used to treat nevus sebaceous.

9:15-10:15 am

Treating High Impact Sites in Psoriasis: Tina Bhutani, MD

• Patients with certain psoriasis phenotypes are at higher risk for progression to psoriatic
  arthritis. Patients at higher risk for joint involvement include those with psoriasis in the nail,
  intergluteal region, scalp, activity in three or more sites, or those with severe disease.
• Patients with scalp psoriasis should be educated to wash their scalp more often because it
  helps to exfoliate scales gently and improves the efficacy of topical medications.
• Intertriginous psoriasis most commonly involves the groin (80-96% of cases). Still, it can also
  be localized to the following areas: axillae, genital area, umbilicus, postauricular area,
  intergluteal cleft, inframammary creases, antecubital fossae, and popliteal fossae.
• In patients with palmoplantar psoriasis, combination therapy is often needed due to it being a 
  difficult-to-treat area. Using topical treatments under occlusion greatly increases efficacy, and 
  adding keratolytics or retinoids helps with hyperkeratosis.
• Patients underreport inverse psoriasis. Educate patients with psoriasis by showing them
  pictures of inverse psoriasis to increase patient reporting of inverse disease involvement.

10:45 am-11:15 am

Navigating Pediatric Vascular Anomalies: Diagnosis and Treatment Insights: Jim Treat, MD

• At birth, hemangiomas are not fully formed and look like a faint red patch or bruise.
• Fully formed “hemangiomas” at birth are not typical infantile hemangiomas; beware of
  sarcomas.
• Segmental hemangiomas are associated with underlying abnormalities and hemangioma
  syndromes. Localized hemangiomas are typically isolated and not associated with
  abnormalities.
• Lumbosacral hemangiomas are highly associated with a tethered spinal cord.
• It is important to recognize pediatric patients with multiple subtle pink patches, as they may havean 
  arteriovenous malformation of the brain or spine.
• If examining a pediatric patient who has a large nevus simplex on the face and cannot push
  tongue to the back of their mouth, the patient should be evaluated for Beckwidth-Wiedman
  syndrome.
• A reticulated port wine stain can be a marker for a genetic syndrome and should be
  evaluated.
• If the lesion looks like a port wine stain but becomes swollen or petechial (bruising): check
  labs to rule out Kasabach Merritt.

11:15-11:45 am

Pediatric Dermatologic Emergencies: Jim Treat, MD

• Koplik spots are often present before the other symptoms of measles, and the rash spreads
  from head to toe.
• Live vaccines can be given to pediatric patients on dupilumab as long as there is shared
  decision making with the patient’s family.
• If a pediatric patient presents with a fever and a deeply red/purple morbilliform rash with
  swollen feet, hands, and ears, be sure to consider Drug Reaction with Eosinophilia and
  Systemic Symptoms (DRESS) as a diagnosis. The patient should be referred to the
  emergency room for treatment.
• Medications that can cause Drug Reaction with Eosinophilia and Systemic Symptoms
  (DRESS) include: Phenobarbital/Phenytoin/Carbamazepine, Lamotrigine, Zonisamide,
  Dapsone, Isonazid, Minocycline, Abacavir, Nevirapine, Raltegravir, Sulfamethoxazole, and
  Sulfasalazine.
• Reactive Infectious Mucocutaneous Eruption (RIME) can occur in patients with mycoplasma,
  influenza, COVID, and other infections. It presents with necrosis of the lips, eyes, and other
  mucosa. There are few or no skin lesions. It can lead to severe mucosal scarring.
• A neonate with peeling of hands and feet is suggestive of congenital syphilis.

12:30-1:30 pm

Recent Advancements in Atopic Dermatitis: New Insights and Treatment Strategies: Alexandra Golant, MD

• Be aware of comorbidities associated with atopic dermatitis: asthma, allergy, allergic rhinitis,
  alopecia areata, osteopenia/osteoporosis, and some ties to vitiligo.
• New American Academy of Dermatology guidelines for systemic treatment of atopic dermatitis
  state that systemic corticosteroids are not a viable treatment option for treating atopic
  dermatitis.
• Delgocitinib cream is the first and only FDA-approved treatment of chronic hand dermatitis.
• One study showed the proportion of patients 6-11 years old with lower stature at baseline
  showed a 5-percentile or greater improvement in height following 16 weeks treatment with
  dupilumab.
• Lebrikizumab and Nemolizumab are approved for patients 12 years and older for the
  treatment of atopic dermatitis.
• OX40 is a promising pathway being investigated in atopic dermatitis that may have a
  remittative effect on disease progression.

1:30-2:30 pm

Alopecia Update: What You Should Know in 2025: Amy Spizuoco, DO

• Types of scarring alopecia include: Discoid Lupus Erythematosus (DLE), Central Centrifical
  Cicatricial Alopecia (CCCA), Lichen Planopilaris (LPP), Dissecting Cellulitis (Follicular
  Occulsion Tetrad), and Folliculitis Decalvans.
• Systemic treatments for Central Centrifical Cicatricial Alopecia include: oral tetracyclines
  (anti-inflammatory), hydroxychloroquine (for rapidly progressing cases), oral minoxidil (adjunct
  therapy), and 5-alpha reductase inhibitors.
• Treatment for lichen planopilaris should include high-potency topical corticosteroids and
  intralesional triamcinolone. In addition, you can use hydroxychloroquine or
  doxycycline/minocycline. For refractory or severe cases, consider methotrexate,
  mycophenolate mofetil, or cyclosporin.
• Folliculitis Decalvans is characterized by tufted hair follicles and chronic neutrophilic
  inflammation. It typically occurs in the fourth or fifth decades of life and is predominantly seen
  in males.
• A study showed that oral Minoxidil 5mg and topical Minoxidil 5% were equally effective in
  treating androgenetic alopecia.
• When treating hair loss with Minoxidil, patients may experience shedding in the first two to four weeks
  of treatment. Patients will start to have visible improvements in two to four months, with full
  results in six to twelve months.
• Ketoconazole shampoo 2% may help patients with androgenetic alopecia, so consider
  adding it to your treatment regimen. It is not FDA-approved for hair loss.

3:15-4:15 pm

Skin as a Window: Identifying Cancer Syndromes through Cutaneous Clues: Anisha Patel, MD

• Paraneoplastic pemphigus is an autoimmune, antibody-mediated condition. It starts on the
  lips and spreads to the skin with hemorrhagic crusts and ulcerations, but skin findings can be
  variable. Diagnosis is made by indirect immunofluorescence.
• Pyoderma gangrenosum is associated with acute myeloid leukemia, myelodysplastic
  syndrome and rheumatologic disease.
• Dermatomyositis is associated with early malignancy; therefore, patients with dermatomyositis
  should be referred for cancer screening. Dermatomyositis is particularly associated with
  ovarian cancer.
• Cutaneous manifestations of Lynch Syndrome/Muir-Torre (Hereditary Nonpolyposis Colorectal Cancer)
  include sebaceous neoplasms that are off the head and neck, as well as keratocanthomas. 
  If a patient has these skin findings, refer them to a genetic counselor.
  Gastrointestinal specialist and gynecologist for further evaluation.
• A child developing several cafe au lait macules will need genetic testing for evaluation of
  neurofibromatosis.
• Patients should be referred to genetic counseling if: multiple family members have the same
  or related malignancy, multiple family members with more than one primary malignancy,
  family members or self with cancer before 50 years of age, and the patient has family members
  with a known mutation.
• The scalp is a common site for solid tumor metastases.
• Acute myeloid leukemia is the most common malignancy to metastasize to the skin.

4:30-5:30 pm

My Approach to AD in 2025: Alexandra Golant, MD

• The American Academy of Dermatology guidelines update gives a strong recommendation for
  topical ruxolitinib in the treatment of atopic dermatitis.
• Studies show Dupilumab reduces the risk of atopic march in pediatric patients versus
  conventional immunosuppressants.
• Atopic dermatitis is classified as moderate or severe if patients have a 10% or more body 
  surface area, involvement in high-impact areas, or if atopic dermatitis is having a significant
  impact on quality of life.
• High-impact areas of atopic dermatitis include: hands, feet, face, axillae, groin, and genitals.
• Delgocitinib cream is a Janus kinase inhibitor that has been approved for the treatment of
  hand eczema in adults, and it does not have a box warning.
• Be sure to include thorough documentation of atopic dermatitis severity including:
  investigator’s global assessment, body surface area, and quality of life to help with medication
  coverage.