Beyond the Rash: What Dermatologists Need to Know About the World of Infectious Diseases

At the 2025 Maui Derm NP+PA Fall meeting in Nashville, Tennessee, Ted Rosen, MD, and Vikash Oza, MD, shared an update on the infectious disease landscape, which is becoming increasingly relevant to dermatologists.¹ Rosen and Oza delivered a rapid-fire tour through emerging pathogens, cutaneous manifestations, and diagnostic pitfalls.

Rosen, a professor of dermatology at Baylor College of Medicine in Houston, Texas, began by reminding the audience that pandemics aren’t over—they’ve just shifted. COVID-19 remains clinically relevant, particularly as long COVID may present with dermatologic sequelae, including urticaria, vitiligo, alopecia areata, and even psoriasis. Rosen highlighted a persistent rise in such cases, especially among young, otherwise healthy patients.

On Mpox (formerly monkeypox), he reviewed hallmark lesion progression and reinforced the importance of asking patients for sexual and exposure histories when relevant. Case studies demonstrated how clinical clues, such as perianal or perioral distribution, can guide suspicion. He also emphasized vaccination access for high-risk individuals, citing CDC tools clinicians should bookmark. With this, Rosen also warned of the global surge in arboviruses (e.g., chikungunya, dengue, Zika), stressing that non-specific viral rashes in returning travelers should always prompt geographic context and serologic workup.

Of notable concern was the rise of antifungal-resistant Trichophyton species, especially T. indotineae, now seen in the US with presentations like tinea corporis and tinea faciei mimicking eczema. Gerson urged clinicians to think beyond steroids and consider resistance testing, where available. He also called out fungal infections, backed by the WHO's recent prioritization. New antifungal agents like olorofim (coming in 2026) may be game-changers but testing infrastructure lags dangerously behind.

Oza, a pediatric dermatologist at NYU Langone Health, shared insights into molluscum contagiosum (MC), emphasizing its resurgence in post-pandemic clinical practice. While MC often resolves spontaneously, its prolonged course and transmissibility can cause significant parental anxiety, particularly in urban settings where cosmetic and social concerns are heightened.

Historically, pediatric dermatologists have relied on a variety of in-office treatments—such as cantharidin, curettage, and irritants—to trigger an immune response. However, treatment approaches have been shaped largely by anecdotal practice rather than robust data, and natural history studies remain limited. Oz cited a UK community study, which reported a 50% persistence rate at 1 year and a 40% transmission rate among family members.

Oza highlighted two recent FDA-approved therapies for MC: cantharidin 0.7% (VP-102), an in-office vesicant therapy derived from blister beetles, and berdazimer sodium 10.3%, a novel nitric oxide-releasing gel applied daily at home. Berdazimer’s pivotal phase 3 trial demonstrated statistically significant lesion clearance over 12 weeks, offering families a convenient, controlled treatment option.² However, he emphasized that both therapies induce inflammation and require careful counseling to manage expectations and adverse effects.

Importantly, not all papules presumed to be MC are benign. Misdiagnosis risks include subepidermal calcified nodules, juvenile xanthogranulomas, pilomatricomas, and even adnexal tumors such as trichoepitheliomas. Dermoscopy was recommended as a valuable tool for distinguishing these entities, as MC typically exhibits a central white core with surrounding crown vessels.

Oza urged clinicians to biopsy atypical lesions and maintain a broad differential, especially in recalcitrant or solitary presentations. Ultimately, while new therapies provide long-awaited treatment options, accurate diagnosis and individualized management remain central to effective dermatologic care as the skin often reflects more than surface disease.

Stay tuned to Dermatology Times all week for exclusive conference coverage and expert insights from Maui Derm NP+PA Fall.

References

1. Oza V, Rosen T. Infectious Disease Update 2025. Presented at: Maui Derm NP+PA Fall 2025; September 20-23, 2025; Nashville, Tennessee.

2. Browning JC, Enloe C, Cartwright M, et al. Efficacy and Safety of Topical Nitric Oxide-Releasing Berdazimer Gel in Patients With Molluscum Contagiosum: A Phase 3 Randomized Clinical Trial. JAMA Dermatol. 2022;158(8):871-878. doi:10.1001/jamadermatol.2022.2721