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Modern Dermatology: Advanced Meds and Social Media Myths


Rob Casquejo, PA-C, spoke with Dermatology Times on new and upcoming medications, addressing unmet needs, and social media misinformation.

At the recent Society of Dermatology Physician Assistants (SDPA) Annual Summer Dermatology Conference, Dermatology Times talked to Rob Casquejo, PA-C, about exciting new medications, accessibility, and the role of social media in the world of Dermatology.

Casquejo is a physician assistant and the founder of the Skin and Cancer Center of Scottsdale. He is also a co-chair of the communications committee for the SDPA.


Robert Casquejo, PA-C: My name is Rob Casquejo. I am a physician assistant currently practicing in Scottsdale, Arizona, by way of Detroit, Michigan. I've been in dermatology for 22 years, and I am also a co-chair on committee for the Society of Dermatology Physician Assistants.

Dermatology Times: What advice do you have for colleagues hesitant to prescribe new products and medications?

Casquejo: This is a very sensitive topic to me, because I've been practicing long enough, and those who've been practicing as long as I have, or longer, we've had bad experiences with medications that were new to us. They were medicines that were not used in other disciplines and came to us for chronic diseases, and there were some problems. There were deaths when the medicine had been approved, and so the medicine was pulled. That sticks in your brain when a new medicine comes out; you remember the 11 patients you had on that medicine, and what you had to explain to them and what you had to do with them in terms of managing their disease, because now they can't take this medicine anymore. It was very difficult, and it is something I will never forget in my career. So, whenever a new medicine comes down the bend, there's always that in the back of my mind: Let's be careful with patient selection. When you look at data, and you see warning labels, the statistics should give you some confidence. You look at statistical risk of bad things, and if there are low numbers, it starts to make you feel better. However, the real test of time, as was the case with this medicine, is when the medicine gets out in the wild. When you start using it, you strip away the parameters and the boundaries that clinical trials create. Now you're using it in very uncontrolled scenarios, and that's when non safety shows itself. So, you need time. You need amounts of people to take it, outside of clinical trial, and you need time to pass to verify that the safety they saw in the trials is, in actuality, what you see with appropriate use of medication outside of trial. With the JAK inhibitors and some of these newer medications, maybe some people didn't experience this, but we just want to be sure that the medicines are safe. It's not that we don't believe the safety data in the trial; it's just that we know there's certain fail safes in place. We just want to make sure, out in the real world and use of this medication over time, that those safety profiles will not change. I think it's just time. I think in 3 to 4 more years, these medicines will probably be used much more widely, and I think that there will be less stigma around them if they hold up outside of clinical trial the way that they should.

DT: What are you most excited about in dermatology right now?

Casquejo: I think it's the development of new therapeutics in these bad, chronic diseases that we treat every day, like eczema. JAK inhibitors being one of them, we can also treat psoriasis. I've been practicing a long time, and I practiced in a pre-biologic world. We had cyclosporine, methotrexate, acitretin, steroids, light booths, and tar. Yes, tar, 2% coal tar. Again, I'm old enough that we painted tar on people and did treatments. Now to have a shot you can do once every 3 months, and you can clear them 100% - I would’ve never believed it. In 2002, if you said there's going to be a shot that you do every quarter and 50% chance, they can be 100% clear, I would have said, “No way. I don't believe it; I don't know what you're drinking but save some for me.” Now we've got an arsenal of medicines that do these very things. Now, out of sight of psoriasis, we're starting to see these medicines for things like eczema, alopecia areata, and it's very exciting, because these are diseases we treat every day. It's nice to start to see the profile expanding.

DT: Where do you think there are unmet needs that require immediate attention?

Casquejo: I would turn that conversation more to not necessarily academics, but I think infrastructure or socioeconomics, maybe. I wish these medicines were cheaper. I wish there were ways to get these medicines to people without the price tag. I understand you've got research and development. You've got what our FDA requires, which is going to cost money over time, manufacturing, etc. There are companies running these. These people need to be paid to develop these medications. I get that. I wish I had an answer. I wish there were ways to make the medicines more accessible financially. If anyone asked me about a wish list, that's what I would put on the top of the list.

DT: How do you address social media and the spread of misinformation?

Casquejo: This is near and dear to me because I am on the communications committee, and we are responsible for handling social media content. There are 2 kinds of ways you can reach out as a professional society- you can reach out to professionals and put content for them. You're giving them case studies to read, or latest literature summaries, things like that. That's not going to mean much to the general public. The other bucket is information for the public. For those people, unfortunately, you can read every survey that people are getting most of their news and information by just looking at social media. The smartest people in the world are scrolling on their phones and getting information. Unfortunately, the general public is getting a lot of wacky stuff. All you have to have is enough viewers, and everything you say must be true, right? We know that that's not the case. So, my solution to that is to fight fire with fire. What you need to do then is you need to have appealable, capable people to create social media that has a million followers, that is competent. Those things overtake what you see in the reels, not the influencers that are just being paid to say what they say, or they see a product and think they know enough to give advice medically. I really think that's the way to do it. The AAD is doing a great job of that. They have one for their members. They have one for the general public, for public consumption. The National Eczema Association - they have some great social media content that not enough people are watching, but it's great. They're doing the right stuff. We need those people. The SDPA, we're creating, targeting, and creating content for public consumption. We're not quite there yet, because it's a lot of work to do it right, but we need those reels to be the first ones that show up. You do that by doing what everyone else does. Organically, try to get the followers and make it available.

[Transcript has been edited for clarity.]

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