November 2024 Atopic Dermatitis and Vitiligo Supplement Recap

The November Case-Based Peer Perspective supplement of Dermatology Times includes a collection of thought-provoking discussions and strategies surrounding tips for improving complex atopic dermatitis and vitiligo treatments from Terry Faleye, MPAS, PA-C, Andrea Rosik, MS, PA-C; and Jayme Heim, MSN, FNP-BC. Be sure to read the highlights from the supplement below. Also, don’t miss a moment of Dermatology Times by signing up for our eNewsletters and subscribing to receive the free print issue and supplement each month.

Part 1

In a recent Dermatology Times Case-Based Peer Perspective custom video series, “Patient Cases Shedding Light on Vitiligo Management,” Terry Faleye, MPAS, PA-C, shared perspectives on managing difficult cases of vitiligo. Faleye, a dermatology physician assistant practicing at DermSurgery Associates in Houston, Texas, presented patient cases to colleagues at a roundtable event to invite discussion on complex manifestations.

Case 1: A 35-Year-Old Female Patient With Vitiligo

The first patient case discussed was a woman aged 35 years who presented with depigmented patches on her face and hands. She had experienced these symptoms for 6 months before seeking dermatological evaluation. According to Faleye, this presentation is typical, with many patients delaying care.

Initial treatment involved tacrolimus 0.3% ointment, but results were modest. Faleye noted, “In clinical practice, many of us were having truly seen that type of benefit with using tacrolimus monotherapy.” After several months, however, the patient began to show some signs of repigmentation.

To enhance results, they added phototherapy, but accessibility posed challenges. “There were probably 3 to 4 other colleagues who had phototherapy...the rest of us either had to send patients to another facility or academic centers,” Faleye explained. Many patients may struggle to maintain phototherapy sessions due to their demanding schedules, Faleye noted.

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Part 2

In a recent Dermatology Times Case-Based Peer Perspective custom video series, “Atopic Dermatitis in Practice: Case Studies From Diagnosis to Treatment,” Andrea Rosik, MS, PA-C, provided insights into managing atopic dermatitis (AD). Rosik, a dermatology physician assistant practicing at Hamzavi Dermatology in Shelby Township, Michigan, assessed 2 patient case studies to offer clinical advice for challenging AD cases.

Case 1: Psoriasis in a Woman With a Complex History

Rosik presented the case of a White woman aged 70 years with a history of hypertension, acid reflux, hypothyroidism, and psoriasis. The patient reported a diffuse rash following a COVID-19 infection, with symptoms affecting her scalp, face, extremities, and torso.

“She was complaining of some itching, flaking, scaling, and redness,” Rosik said. “She had a worsening of her skin condition, especially after an illness such as COVID-19.”

However, the roundtable attendees considered differential diagnoses, including an eczematous process, contact dermatitis, or a psoriasiform drug eruption. A biopsy was performed, revealing psoriasiform spongiotic dermatitis. This result prompted the group to discuss various interpretations of the biopsy findings, concluding that psoriasis, drug eruptions, or contact dermatitis could all be plausible.

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Part 3

During a recent Dermatology Times Case-Based Peer Perspective custom video series, “In the Clinic: Exploring Atopic Dermatitis Through Real Patient Cases,” Jayme Heim, MSN, FNP-BC, provided insights into managing atopic dermatitis (AD).

Heim, a nurse practitioner at West Michigan Dermatology in Grandville, Michigan, detailed 2 patient case studies discussed in a recent roundtable of western Michigan–based dermatology advanced practice providers (APPs). Heim said each APP’s years of experience varied, from less than 5 to more than 20, making for a well-rounded, vibrant discussion.

Case 1: A 20-Year-Old Woman With Short History of Hand Rash

The first case discussed was that of a 20-year-old college student with a 6-month history of hand rash. According to Heim, the woman recently began an internship as a laboratory technician and believes the various chemicals could be causing the rashes.

To start the discussion, the cohort said this is a patient type often referred to their respective dermatologic practices. Heim noted several important factors: who referred the patient, previous therapies such as prednisone, and whether any chemicals she noticed worsened the rash.

Heim says the patient was initially diagnosed with contact dermatitis. Upon negative results from a patch test, she was started on topical corticosteroid cream with instructions to apply it with gloves. This gave her partial improvement in symptoms, but she still saw frequent flare-ups and noted that the constant use of gloves was exacerbating the condition.

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