Expert Insights on Uncommon Dermatoses from Walter Liszewski, MD

At the Maui Derm NP+PA Fall 2025 conference, Walter Liszewski, MD, a board-certified dermatologist and associate professor of dermatology at the Northwestern Feinberg School of Medicine in Chicago, Illinois, shared valuable insights during his session, “Outside the Box: Treating the Uncommon Dermatosis,” with Ted Rosen, MD.¹ Liszewski focused on lichen planus and lichen sclerosus; conditions that, while not the most common in dermatology, often present significant diagnostic and therapeutic challenges.

In the talk, Liszewski emphasized that hydroxychloroquine can be effective across many forms of lichen planus. However, treatment success varies. For instance, cutaneous lichen planus typically responds well to therapy, while other variants, such as lichen planopilaris and lichen planus pigmentosus, tend to be more refractory. He advised clinicians to begin with topical treatments and escalate care, if patients fail to respond, including performing a biopsy. He also noted the chronic and sometimes intractable nature of oral lichen planus, often requiring multiple therapeutic trials before achieving symptom control.

During the Grand Rounds in Dermatology interactive panel, Liszewski presented a unique case of atypical polymorphous light eruption (PMLE).² Unlike classic PMLE, which commonly affects the face, neck, and extremities, this patient, a Caucasian male in his 30s, had involvement of the eyelids. Through minimum erythema dose testing, Liszewski confirmed both UVA and UVB sensitivity, highlighting the utility of diagnostic phototesting. He underscored that PMLE can have diverse clinical manifestations, reinforcing the importance of maintaining a broad differential when evaluating suspected photodermatoses.

“Polymorphous light eruption is called polymorphous because there's so many unique and atypical presentations. It's not a one-size-fits-all for what we see,” Liszewski said.

Looking ahead, Liszewski expressed enthusiasm about emerging treatments for chronic spontaneous urticaria (CSU). While omalizumab has been a cornerstone therapy, new agents such as dupilumab and oral Bruton’s tyrosine kinase inhibitors like remibrutinib are on the horizon. With dermatologists often being the first point of care for CSU, these advancements represent a promising shift in the management landscape, offering improved symptom control and quality of life for patients.

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

References

1. Liszewski W, Rosen T. Outside the Box: Treating the Uncommon Dermatosis. Presented at: Maui Derm NP+PA Fall 2025; September 20-23, 2025; Nashville, Tennessee.

2. Davis M, Fallon Friedlander S, Liszewski W, Martin G, Rosen T. Grand Rounds in Dermatology. Presented at: Maui Derm NP+PA Fall 2025; September 20-23, 2025; Nashville, Tennessee.