Elevate-Derm Summer Conference Clinical Insights Day 3

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

Day 3: Saturday, July 26, 2025

7:30-8:30 am

Wake Up Dermatology: It's Time to Talk About Sleep: The Importance of Sleep for Skin Health Disease: Tina Bhutani, MD

• Stages of sleep: awake, drowsy, stage 1 sleep, stage 2 sleep, slow wave sleep (stages 3 and 4 sleep), REM (rapid eye movement) sleep.
• Sleep changes with age; over time, total sleep time continues to drop.
• Slow wave sleep serves critical functions for memory formation and immune functioning. The more we sleep, the better our immune system works.
• Getting good sleep two days before a vaccine is vital for optimizing the vaccine response.
• Sleep loss has short-term and long-term effects, including increased risk of infections, increased stress response, decreased response time, increased obesity, increased risk of diabetes, heart attacks, strokes, and mental health problems.
• The ideal number of hours of sleep recommended for adults is seven to eight hours.
• Patients with psoriasis are at higher risk for developing sleep apnea, and patients with sleep apnea are at higher risk for developing psoriasis.
• One study showed that for each hour increase in average nightly sleep, patients with psoriasis have a 33% decrease in the odds of having a history of myocardial infarction. Another study showed that night shift work increases the risk of psoriasis.
  
  
  

9:15-10:15 am

Immunotherapy in Dermatology: Innovations & Clinical Applications: Anisha Patel, MD

• There are two forms of immunotherapy, suppression immunotherapy and activation immunotherapy.
• MRNA vaccines activate the host’s immune system against specific tumor antigens.
• Talimogene laherparepvec is an oncolytic vaccine used in dermatology that can be used in non-resectable tumors. Other vaccines used in dermatology are MRNA vaccines. Cellular therapies in dermatology focus on enhancing lymphocytes. Some examples of these are tumor-infiltrating lymphocyte therapy (used in melanoma) and chimeric antigen receptor T-cell therapy (used in melanoma and skin disease).
• Immune checkpoint inhibitors are being used in dermatology to treat melanoma, cutaneous squamous cell carcinoma, basal cell carcinoma, and Merkel cell carcinoma.
• Cutaneous adverse events caused by checkpoint inhibitors include: morbilliform drug eruption, eczema, psoriasis, lichenoid drug eruption/lichen planus, granulomatous dermatitis,  vitiligo, bullous pemphigoid, and keratocanthoma/squamous cell carcinoma.
  
  

10:45-11:45 am

Complex Medical Dermatology: Top Diagnoses You Can’t Afford to Miss:  Lauren Madigan, MD, and Anisha Patel, MD

• Solid organ transplant patients have an increased risk of squamous cell carcinoma. Allogeneic hematopoietic stem cell transplant patients have an increased risk of basal cell carcinoma, malignant melanoma, and squamous cell carcinoma. If combined with radiation treatment, there is also an increased risk of basal cell carcinoma in the radiated area.
• Azathioprine is an immunosuppressive medication associated with increased cancer risk, so sirolimus is a preferred alternative.
• When evaluating a patient with pruritus without a rash, systemic causes are common and should be prioritized in the differential diagnosis. Consider if the itching is caused by a metabolic, malignant, medication, neuropathic, chronic infection, psychogenic, or cryptic issue.
• Approach patients with pruritus without a rash by doing a thorough history and review of systems, a complete skin exam, and initiating laboratory evaluation.

1:00-1:30 pm

The Evolving Landscape of STIs: Amy Spizuoco, DO

• Penicillin G benzathine is the treatment of choice for all stages of syphilis. A single dose is recommended for early syphilis (infected for less than a year); if the disease has been present for more than a year, multiple doses of penicillin may be necessary.
• In pathology, Henderson-Patterson bodies are pathognomonic for molluscum contagiosum. Koliocytes are pathognomonic for HPV.
• Post-scabietic itch can last for weeks after successful eradication of mites and does not necessarily indicate treatment failure; however, recurrent or persistent symptoms should prompt evaluation for reinfestation, inadequate treatment, or misdiagnosis.
• Trichophyton mentagrophytes Genotype VII is an emerging sexually transmitted dermatophyte.
• Trichophyton mentagrophytes Genotype VII is treated with oral terbinafine 250 mg daily for four to eight weeks. Recurrence is common.

1:30-2:00 pm

Unraveling Chronic Itch: Douglas DiRuggerio, PA-C

• The key neuropeptides in itch are: substance P, calcitonin gene-related peptide, vasoactive intestinal peptide, galanin, endothelin-1, and neuropeptide Y.
• Patients' itch level can be self-reported with the peak pruritus numerical rating scale (pp-NRS) from 0-10, with 0 being no itch and 10 being the worst itch imaginable.
• Predisposing factors to chronic itch in the elderly include: age-related changes in barrier function, neuronal changes and neuropathies, and immunosenescence.
• Always rule out parasitic infection in a pruritic patient who has recently traveled and has elevated eosinophils.
• If timing is right and the biopsy shows interface dermatitis, the drug is a possible cause of dermatitis. The patient would need to discontinue the offending drug for at least 6 weeks to determine if it was the cause of the rash.
• Topical treatment is the mainstay of therapy for pruritus, with a goal of skin hydration and barrier repair.

2:00-2:30 pm

Vitiligo for Advanced Clinicians: Key Takeaways: Naiem Issa, MD

• Vitiligo patients with an affected body surface area greater than 5%, darker skin pigment,  and/or facial or hand involvement have a high psychosocial burden on quality of life.
• Ruxolitinib 1.5% cream is a potent inhibitor of Janus kinase 1 and 2 and the first and only FDA-approved drug for non-segmental vitiligo. Alternatively, tofacitinib 2% is less expensive and may also be an option.
• The most common adverse events from vitiligo patients using Ruxolitinib are: acne, nasopharyngitis, pruritus, and dermatitis.
• Use of topical Ruxolitinub 1.5% cream in combination with other therapeutic biologics (Janus kinase inhibitors or potent immunosuppressants such as azathioprine or cyclosporine) is not recommended.
• There is a high correlation with vitiligo and positive thyroid peroxidase antibodies,  hypothyroidism, and autoimmune thyroiditis.
• In adults, a halo nevus may indicate the presence of melanoma within the nevus or elsewhere on the body.

2:45-3:15 pm

Optimizing Biologic Selection and Treatment Sequencing in Psoriasis: A Case-Based Approach: Megan Prouty, MD

• Psoriasis severity can be categorized by body surface area. Mild is less than 3%, moderate is 3-10%, and severe is greater than 10% body surface area. However, the disease may be severe even with a 1% body surface area if psoriasis is affecting a functional area such as hands,  feet, or genitals.
• Patients are NOT a candidate for methotrexate treatment if: possibly pregnant or breastfeeding, have chronic liver disease, are not willing to discontinue alcohol intake, have chronic cytopenia, or have chronic kidney disease.
• Always refer psoriasis patients with axial joint symptoms to rheumatology on initial evaluation.
• If a psoriasis patient has symptoms that are concerning for inflammatory back/hip pain, strongly consider starting treatment with a TNF-alpha inhibitor.

4:00-4:30 pm

Interesting Cases from Inpatient Consults: Lauren Madigan, MD

• Sweet’s syndrome is characterized by the sudden onset of tender, erythematous papules or plaques with accompanying fever and neutrophilia. Consideration for an underlying malignancy is necessary, since the cutaneous eruption may be the first sign of an occult malignancy or relapse in a patient with a cancer history.
• Pyoderma gangrenosum is frequently associated with systemic disease.
• VEXAS syndrome should be suspected in a patient (particularly males over the age of 50) who has refractory systemic inflammation, hematologic abnormalities, and characteristic cutaneous lesions (neutrophilic dermatitis, vasculitis, and chondritis).
• Vascular, infectious, and neoplastic ulcers are the most common mimickers of pyoderma gangrenosum, and failure to exclude these can lead to inappropriate immunosuppression,  which may worsen the underlying condition and precipitate the severity of complications.

4:30-5:00 pm

Kodachrome Case Studies: Lauren Madigan, MD

• Linear immunoglobulin A is a rare autoimmune blistering skin disease that appears like a “crown of jewels.” It can be drug-induced by intravenous vancomycin.
• Niacin deficiency can present with a “Casal’s necklace.” This dermatitis occurs around the neck and creates a distinct, collar-like pattern.
• Monilethrix is a rare, inherited hair disorder that causes hair to appear dry, brittle, and beaded.
• Tongue telangiectasias can be seen in systemic sclerosis.
• Always ask a patient with erythema ab igne why they are using heat on their skin; it could lead to a systemic diagnosis.
• Rapid vitiligo-like depigmentation could be a sign of melanoma present elsewhere on the body. All patients with “vitiligo” should have a full-body skin exam.