Dr. Micheletti points out highlights from his lecture, Infectious Disease Updates 2025, at the 6th Annual Elevate-Derm Alliance Conference at the JW Marriott Water Street in Tampa, Florida.

In this video

In conversation with Veronica Richardson, Dr. Micheletti frames the update around "old things being new again, new things emerging." He starts with drug-resistant dermatophyte Trichophyton indotineae — long known in South Asia but only recently connected in the U.S. through New York City. These patients often have a travel history to Bangladesh or India and present with atypical, widespread, inflammatory tinea that fails topicals and the usual oral agents like terbinafine, griseofulvin, and fluconazole. Itraconazole is the agent of choice, but diagnosis requires a fungal culture (a DNA test) and specifically alerting the lab up front to look for the organism.

He then turns to diseases resurfacing outside the clinic walls: leprosy, now thought to be endemically spreading in central Florida without a travel link, presenting classically as an insensate hypopigmented patch, leonine facies, thickened ear lobes, and prominent nerves. Measles is "making a comeback" with falling vaccination rates — a morbilliform eruption in a sick patient with viral symptoms and Koplik spots that warrants asking about vaccination history. Finally, he positions dermatology providers as de facto public health officers and makes the case for antibiotic stewardship, asking whether there's a transition point off the antibiotic (doxycycline to spironolactone in acne) and defending evidence-based agents like doxycycline and clindamycin in HS, where most resistance data stems from non-evidence-based antibiotics.

  • Suspect Trichophyton indotineae in patients with a South Asia travel history and atypical, widespread, refractory inflammatory tinea; confirm with a fungal culture and specifically tell the lab you're looking for it, and treat with itraconazole.
  • Keep leprosy on your radar in the southeast, particularly central Florida, where endemic spread now occurs without travel — look for an insensate hypopigmented patch, leonine facies, thickened ear lobes, and prominent nerves.
  • Distinguish true measles from routine morbilliform eruptions by looking for viral symptoms and Koplik spots and by asking about vaccination history — one in five unvaccinated patients who get measles ends up hospitalized.
  • Practice antibiotic stewardship by asking if a patient truly needs to stay on the antibiotic and whether there's a natural transition point (e.g., doxycycline to spironolactone in acne).
  • When antibiotics are necessary — as with mild-to-moderate HS — favor evidence-based, recommended agents like doxycycline and clindamycin, since most resistance arises from non-evidence-based prescribing.