Elevate-Derm Summer Conference Clinical Insights Day 4

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

Day 4: Sunday, July 27, 2025

8:00 am-9:00 am

Complex Psoriasis Cases: Navigating Diagnostic & Therapeutic Challenges: Megan Prouty, MD

• If a patient has an active strep infection, it is appropriate to treat, but antibiotics are not effective in clearing guttate psoriasis.
• One to two doses of an interleukin-23 inhibitor are a convenient and highly effective way to treat new-onset guttate psoriasis, dosed approximately a week apart. Often only one dose is needed.
• In patients on a biologic medication with focal residual psoriasis involvement (approximately 3% or less), consider adjunctive therapies instead of changing biologic treatment.
• For patients with a history of thromboembolic events, be cautious with Janus kinase inhibitors such as upadactinib.
• Mycosis fungoides/cutaneous T-cell lymphoma can appear identical in morphology to psoriasis. Consider biopsy of psoriasiform plaques in sun-protected areas, especially if areas appear poikilodermatous or atrophic.
• Retrospective data support the use of biologics in patients with a history of malignancy as safe and effective. Interleukin-23 and intraleukin 12/23 are preferred in these situations.
• Consider HIV testing in patients who present with erythrodermic psoriasis or psoriasis refractory to multiple treatments (particularly young men, as this is the most frequent patient population in case reports). In conjunction with Infectious Disease, if a patient is on antiretroviral therapy, consider the use of Interleukin-23 or Interleukin-17 inhibitors.

9:00 am-9:30 am

The Art of Connection: Building Meaningful Rapport with Skin of Color Patients: Buchi Neita, PA-C

• Implicit bias is a negative attitude or internalized stereotypes that unconsciously affect our perceptions, actions, and decisions.
• By 2044, more than half of all Americans are projected to belong to a minority group.
• To build rapport with skin of color patients, it is important to find a common ground. Take an interest in your patient, discuss shared experiences and hobbies, personalize the encounter,  and avoid generalizations or stereotypes.
• Body language and tone are key aspects of making a patient feel comfortable. Sit down facing the patient at eye level and make eye contact, mind your tone and facial expressions, and mirror the patient’s body language.
• Utilize shared decision-making. Present the full range of treatment options, discuss risks and benefits, ask what therapies the patient is open to, allow for questions, and provide clear instructions, and understand that the patient may need time to make a decision, and offer follow-up.
• Recognize the higher risk of hyperpigmentation and keloids in skin of color patients. Approach all procedures with caution.

9:30 am-10:00 am

Dermatologic Conditions in Skin of Color Patients: Buchi Neita, PA-C

• Volar/acral melanocytic macules and plantar pigmentation are normal variations in skin of color patients. They are asymptomatic, hyperpigmented macules and patches on the plantar surface in African American patients. Dermoscopy primarily reveals a homogeneous pattern.
• Management of keloid scars includes: intralesional steroids (high concentrations), 5-fluorouracil, cryotherapy, silicone gel sheets, and surgery with caution (adjunct treatment with surgery to prevent recurrence includes radiation, intralesional steroids, pressure, and silicone sheets).
• Traction alopecia is a trauma-induced hair loss resulting from continuous and excessive pulling of the hair shaft. Management includes avoiding high-tension hairstyles, topical and intralesional steroids, topical and oral minoxidil, oral antibiotics, and hair transplantation.
• Patients may develop discoloration of the skin in sun-exposed areas when taking kratom in high doses.
• Hydrochlorothiazide can cause drug-induced photodistributed hyperpigmentation. Consider referral to the patient's primary care provider to choose an alternate diuretic medication.

10:45-11:45 am

Lessons Learned in Acne and Rosacea: Shanna Miranti, PA-C

• The mechanism of action for isotretinoin is apoptosis of sebaceous and meibomian gland cells.
• Patients who are candidates for isotretinoin therapy have moderate-severe acne vulgaris, have tried and failed appropriate American Academy of Dermatology options, are frustrated with the lack of efficacy of the current regimen, and/or are developing scarring.
• Isotretinoin should be taken with a high-fat meal (at least 20 grams of fat).
• Topical tazarotene can be used post-isotretinoin therapy for acne maintenance/prolonging the results of isotretinoin therapy.
• Pseudo-acne fulminans is the sudden onset of nodules and ulcerative/crusted acne lesions.