Elevate-Derm Summer Clinical Pearls

Dermatology clinicians looking to sharpen their approach to hair loss, hyperpigmentation, treating older adults, and JAK inhibitor management came away with practical strategies they can put into practice right away. Dermatologists, nurse practitioners, and physician assistants described changes in how they examine, counsel, and follow up with patients during sessions and interviews with Dermatology Times at the 2026 Elevate-Derm Summer Conference in San Diego, California.

Elevate-Derm Summer Clinical Pearls

Failing to examine the scalp is one of the most common mistakes in hair loss visits, Oyetewa Asemba, MD, a dermatologist in Houston, Texas, told Dermatology Times. Patients often tell her they felt dismissed or judged when a previous clinician skipped the exam. Sometimes clinicians hesitate because they don't want to disturb a hairstyle, she said. "If a patient has come to you for hair loss, they are expecting you to get in there," Asemba said. When extensions or a style block the view, she asks patients to come back with their hair loose and explains why. She said that explanation can build rapport rather than cause offense.

Regimens should also match hair type. Sebum has a harder time traveling down a curly hair shaft, so these patients rely more on conditioners and oils for moisture. Patients with straighter hair may need to wash more often. "Curly hair patients should not wash every day because it will cause breakage for their hair," Asemba said.

Styling habits matter for vehicle choice, too. Roflumilast 0.3% foam is one of Asemba's preferred treatments for seborrheic dermatitis, and she estimates it is effective for about 85% of her patients. But for a patient with curly hair who has had a blowout or silk press, a water-based foam can make the hair revert toward its natural texture. "If someone paid $400 for their special blowout, they might be very upset with you for giving them a water-based treatment," she said.

Asemba also recommended treating postinflammatory hyperpigmentation (PIH) at the same time as the condition causing it, rather than waiting for the inflammation to resolve. For some patients, she said, the pigmentation is "more devastating than the diseases that cause it." With acne, she starts on pigment right away. "If you have acne, I know it's going to cause hyperpigmentation. So we should already be doing some things for your pigment now as we're treating the acne," Asemba said. According to Asemba, this approach can help prevent some PIH and build rapport, although pigment does not always return fully to baseline.

How Can Geriatric Care Principles Improve Treatment for Older Adults?

When supporting older patients, Daniel Butler, MD, vice chair of education at the University of Arizona, encourages clinicians to start with what the patient most wants from treatment, he told Dermatology Times. That could be clearing lesions, relieving itch or joint pain, or resolving scalp flaking. Instead of coming in with a set plan, he offers a menu of options and explains the reasoning behind each one.

Butler also pointed to the 5Ms of geriatric care (ie, mobility, what matters most, medications, mentation, and multicomplexity), which he learned about from a geriatrician's lecture at the meeting. He described them as checkpoints to return to, not a requirement for every visit.

Medications deserve particular attention. A patient with hives may arrive taking several antihistamines and prednisone. Once targeted treatment begins, Butler said, clinicians should consider whether some of those can be stopped. He acknowledged that dermatologists contribute to polypharmacy too. "We have in our skill set the ability to take some of those low-hanging fruits away and simplify our approach," he said.

What Should Clinicians Do When Cholesterol Rises on a JAK Inhibitor?

In a case-based panel, Eileen Cheever, MPAS, PA-C, Victoria Garcia-Albea, NP, Keri Holyoak, PA-C, and Buchi Neita, PA-C, presented a 42-year-old woman with moderate to severe atopic dermatitis. Topicals, phototherapy, and dupilumab had not worked for her. After 12 weeks on upadacitinib 15 mg daily, her body surface area involvement dropped from 24% to about 3% and her sleep returned to normal. However, her LDL rose from 108 to 192 mg/dL. Because her 10-year atherosclerotic cardiovascular disease risk was 5.9%, the team consulted her primary care clinician, and a repeat panel confirmed the elevation. They continued the JAK inhibitor and added rosuvastatin 10 mg. At the 3-month follow-up, her disease was still controlled and her cholesterol had stabilized.

The takeaway, Cheever said, is that "cholesterol elevations are expected, so prepare for them." She urged clinicians to counsel patients and consult with primary care colleagues rather than "unnecessarily pulling your patients off these medications without looking at other options."

Putting Patient-Centered Lessons Into Practice

For clinicians heading back to clinic, the lessons are concrete. Examine the full scalp, and ask about hair care and styling before choosing a vehicle. Start managing pigment alongside acne and other inflammatory disease. Use the 5Ms and a medication review to guide care for older adults. When lipids rise on a JAK inhibitor, counsel the patient and bring in primary care before stopping a therapy that is working. Across the sessions, the common thread was that better outcomes often start with asking the right questions about a patient's hair, goals, history, or medication list before writing the next prescription.

Get more practical tips from leaders in the field at DermNexus. https://www.gotoper.com/courses/derm-nexus-the-inflammatory-disease-and-innovations-congress-for-nppas

References

1. Asemba O. Interview with Dermatology Times. Elevate-Derm Summer Conference; 2026; San Diego, CA.
2. Taylor SC, Grimes PE, Callender VD, et al. Treatment recommendations for acne-associated hyperpigmentation: Results of the Delphi consensus process and a literature review. J Am Acad Dermatol. 2023;89(2):316-323. doi:10.1016/j.jaad.2023.02.053. PubMed
3. Butler D. Interview with Dermatology Times. Elevate-Derm Summer Conference; 2026; San Diego, CA.
4. Sohn EH, Tung EE, Takahashi PY, Verdoorn BP. Clinician’s guide to geriatric assessment. Mayo Clin Proc. 2024;99(11):1773-1784. doi:10.1016/j.mayocp.2024.08.017.