Expert Interviews

Menopause can bring dryness, sensitivity, acne, and loss of firmness, requiring dermatologists to adapt skin care to patients’ changing needs.

Although the disease mechanism is not fully mapped, mast cell activation sits at its center, and the BTK pathway is where multiple routes converge. That convergence is the rationale for targeted inhibition.

When a patient prioritizes preserving taste and independence, differences in plasma protein binding, tissue distribution, and real-world tolerability become central considerations in selecting among hedgehog pathway inhibitors.

A young construction worker managed with photoprotection alone continues to have breakthrough phototoxicity and mildly elevated aminotransferases. The discussion covers liver monitoring, biopsy thresholds, and when drug therapy becomes necessary.

Guideline-based photoprotection, vitamin D repletion, and expanded access to a glycine transporter inhibitor frame the next steps for a teenager with EPP. Hepatitis vaccination and liver imaging guide long-term surveillance.

Long-term response data, trial response criteria, a structured laboratory schedule, and symptom-specific supportive care together determine whether patients can remain on hedgehog inhibitor therapy long enough to benefit.

Access, safety counseling, and speed of response shape the choice of a JAK inhibitor. Dr. Ungar explains how the alopecia areata safety record frames risk-benefit conversations with patients.

All three approved JAK inhibitors for severe alopecia areata achieve meaningful regrowth. Dr. Ungar reviews their selectivity and pivotal trial results while cautioning against cross-trial comparisons.

Angela Fitch, MD, co-founder and chief medical officer of Knownwell, discussed GLP-1 access strategies and a proposed randomized trial in hidradenitis suppurativa at Fall Clinical 2026.

New trial data on povorcitinib, upadacitinib, and remibrutinib show meaningful HiSCR responses and reassuring cardiovascular safety. The panel discusses how to present this evidence to patients.

JAK and BTK inhibitors approach HS inflammation from different angles inside the cell. Laura Bush breaks down how each emerging oral therapy interrupts the disease process.

At Fall Clinical 2026, Joel Gelfand, MD, MSCE, reviewed GLP-1 candidacy, weight conversations, and an upcoming monotherapy trial in psoriasis.

Persistence and adherence, not efficacy claims alone, distinguish IL-23 biologics in practice. Real-world claims data reveal how administration setting and dosing interval shape whether older patients stay on therapy.

Injection anxiety, transportation barriers, and Medicare Part B eligibility converge in this case to make office-administered biologic therapy not a fallback, but often the most realistic path to sustained treatment.

At Fall Clinical 2026, Angela Fitch, MD, discussed GLP-1 prescribing by dermatologists and the metabolic and inflammatory link to psoriasis.

Joel Gelfand, MD, MSCE, discussed the role of GLP-1 agonists in addressing the metabolic comorbidities of psoriatic disease at Fall Clinical 2026.

A methodical up-titration schedule and clear expectations help patients reach the point where advanced therapy is appropriate. With no approved CIndU medication, clinicians are extrapolating from CSU.

Second-generation H1 antihistamines remain first-line therapy, yet most patients do not reach control even at higher doses. The panel outlines where antihistamines work, where they stop working, and what that leaves unaddressed.

On this episode of Don’t Be Rash, host Andrew C. Krakowski, MD, welcomes Lawrence Eichenfield, MD, pediatric dermatologist, to discuss topical corticosteroid potency, dosing, and where they fit alongside nonsteroidal agents.

Christopher Bunick, MD, PhD, reviews data on investigational atopic dermatitis agents presented at EADV 2026 and biomarker findings for upadacitinib.

At Fall Clinical 2026, Todd Schlesinger, MD, explained recent exosome regulatory progress, the remibrutinib label update for symptomatic dermographism, and ongoing clinical trials at his trial center.

Missed clues, social isolation, and mildly elevated liver enzymes shape the workup of a teenager with confirmed classical EPP. The discussion balances biochemical testing, vitamin D repletion, and realistic photoprotection.

For a functional older patient with recurrent, infiltrative disease after repeated excisions, multidisciplinary review supports hedgehog inhibition with curative intent and a potential path toward less morbid definitive treatment.

A 15-year-old with eight years of light-triggered pain and swelling had been treated for sunscreen allergy, eczema, and sunburn. The case shows how EPP presents and how it differs from other cutaneous porphyrias.

Class-wide laboratory monitoring, a predictable adverse event timeline, and emerging resistance mechanisms shape how hedgehog inhibitor therapy is initiated, sustained, and eventually complemented by agents in development.

A patient with 45 percent hair loss and a wedding in six months illustrates why psychosocial burden can reclassify disease severity and why expectation setting must begin before treatment does.

Dismissing alopecia areata as cosmetic delays appropriate care. Dr. Ungar frames it as an inflammatory autoimmune disease and explains how severity, not scalp percentage alone, should guide the move to systemic therapy.

Which vitiligo patients need oral vs topical JAK inhibitors? Iltefat Hamzavi, MD, shares his approach at Fall Clinical 2026.

Not every flare signals treatment failure. The panel distinguishes manageable fluctuations from true loss of response and weighs how comorbidities and insurance shape next-line biologic selection.

A second patient, initially helped by adalimumab, shows how HS can outpace a first-line biologic over time. The panel discusses recognizing secondary failure and rebuilding a treatment plan.