20 Clinical Pearls in 20 Minutes: Insights from the Winter Clinical Miami Experts

April Armstrong, MD, MPH; Lawrence Green, MD; Terrence Keaney, MD; and Linda F. Stein Gold, MD, delivered a Winter Clinical staple session, “20 Tips in 20 Minutes.” This fast-paced panel offered practical clinical pearls, off-label treatment insights, and high-yield practice management strategies for attendees.¹

1. Refractory Genital Dysesthesia: Think Beyond Topicals

Patients with scrotal or genital dysesthesia may fail multiple topical therapies. Case examples demonstrated meaningful symptom relief with dupilumab, highlighting a systemic option when quality-of-life impact is high, surface area is small, and distress is significant.

2. “Knockout” IL-23 Therapy for Guttate Psoriasis

Guttate psoriasis can be episodic yet occasionally evolve into chronic plaque disease. Short-course IL-23 inhibition (eg, baseline and week 4 dosing) has produced prolonged remissions in case reports, possibly by targeting upstream immune memory.

3. AI to Recapture Lapsed Patients

Artificial intelligence tools can scan the EMR for overdue follow-ups (akin checks, Botox, chronic disease monitoring, etc.), automatically text patients, and track conversions. In one practice, this strategy generated substantial revenue over 4 months, demonstrating AI’s immediate operational value.

4. Off-Label Topicals for Male Genital Psoriasis

Nonsteroidal agents such as roflumilast have shown benefit in sensitive-site psoriasis where traditional topicals may be poorly tolerated.

5. Consider SAPHO Syndrome

Palmoplantar pustulosis accompanied by sternal pain should prompt consideration of SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis). Biologic therapy has shown improvement in both cutaneous and osteitic manifestations.

6. Treating Hypopigmentation Creatively

Tacrolimus may stimulate melanogenesis and can be paired with prostaglandin analogues for localized hypopigmentation. For larger areas, ruxolitinib cream may reduce inflammation and support repigmentation strategies.

7. Delegate Carefully

Delegation can improve efficiency but carries medical-legal risk. Proper training, ownership of expertise, complication tracking, and quarterly review are essential to maintain quality.

8. Pediatric Vitiligo: Emerging Topical Options

Though not FDA-approved for vitiligo, roflumilast and tapinarof have shown encouraging repigmentation in small case series, especially for facial involvement.

9. Nail Lichen Planus and Low-Dose Naltrexone

Refractory nail lichen planus may respond to low-dose naltrexone (eg, 3 mg daily), which carries a relatively favorable safety profile compared to traditional systemic therapies.

10. Hair Biopsy Pearl

When removing scalp sutures after punch biopsies, use a brightly colored glove to contrast dark sutures, improving visualization and efficiency.

11. Invest in Trichoscopy and Imaging

AI-assisted trichoscopy provides quantitative hair metrics, shortens visits, reduces subjectivity, and streamlines counseling in high-volume hair practices.

12. Granuloma Annulare: Try Nonsteroidals

Topical ruxolitinib and roflumilast have demonstrated improvement in granuloma annulare in small reports, offering low-risk alternatives for difficult cases.

13. Biologics for Darier Disease

Refractory Darier disease has shown improvement with dupilumab and tralokinumab, suggesting a possible Th2-mediated component in select patients.

14. Use AI for Prior Authorizations

ChatGPT-generated appeal letters can efficiently produce comprehensive, persuasive documentation. As insurers increasingly use automation, AI-to-AI communication may enhance approval success.

15. AI Is Changing Practice Marketing

Search behavior is shifting from traditional Google SEO to AI-driven engines that aggregate data from platforms like Yelp and Reddit. Thus, dermatology practices must diversify their digital presence accordingly.

16. Discoid Lupus: Nonsteroidal Topical Options

Tapinarof and roflumilast have demonstrated visible improvement in discoid lupus erythematosus in early reports, expanding options for steroid-sparing management.

17. Oral Lichen Planus: Combination Therapy

Oral acitretin combined with topical corticosteroid paste has outperformed topical therapy alone in symptomatic oral lichen planus.

18. Don’t Forget Medicare Code G2211

The add-on code G2211 may be used with E/M visits involving longitudinal management of complex chronic dermatologic disease like psoriasis and atopic dermatitis, but not when billing separate procedures.

19. Implement Online Booking

Online scheduling is now essential. Third-party platforms may provide greater customization and schedule optimization than native EMR tools.

20. Ruxolitinib’s Expanding Off-Label Footprint

Topical JAK1/2 inhibitor, ruxolitinib, continues to show promise across diverse inflammatory and granulomatous dermatoses with minimal local adverse effects.

Reference

1. Armstrong A, Green L, Keaney T, Stein Gold L. 20 Tips in 20 Minutes – Medical and Practice Management Tips That Help Me in My Practice. Presented at: 2026 Winter Clinical Miami Dermatology Conference; February 27-March 1, 2026; Aventura, FL.