Thinking Outside the Box: Diego Ruiz Dasilva, MD, FAAD, on the Power of Case-Based Combo Therapy

“Dermatology is historically a field of combination therapy of off-label medicine, so we shouldn't be scared to push the bar, combine things, and think outside of the box for our patients…to give them the best relief,” Diego Ruiz Dasilva, MD, FAAD, told Dermatology Times.

Ruiz Dasilva, a general dermatologist at Forefront Dermatology in Virginia Beach, Virginia, and assistant professor at Eastern Virginia Medical School, discussed key themes from his case-based session at the 2026 Winter Clinical Miami conference and outlined areas in need of greater clinical and research attention.

Copresenting with James Del Rosso, DO, Ruiz Dasilva participated in a session centered on complex, real-world cases.¹ The discussion emphasized case-based learning across a spectrum of challenging inflammatory and oncologic conditions, including atopic dermatitis (AD), cutaneous T-cell lymphoma, and paradoxical or facial eruptions associated with certain biologic therapies. A recurring theme was the importance of a multipronged treatment strategy for patients who fail to respond adequately to monotherapy. The presentation highlighted the role of combination regimens and thoughtful off-label use of therapies, reinforcing dermatology’s long-standing tradition of individualized, mechanism-driven care for difficult-to-treat patients.

Looking ahead, Ruiz Dasilva identified chronic pruritus as a critical and underrecognized disease state deserving greater focus in 2026 and beyond. Although advances in AD and prurigo nodularis have improved outcomes, he emphasized that itch remains the primary driver of diminished quality of life and health care utilization. Importantly, many patients experience severe pruritus without fitting neatly into established diagnostic categories. Chronic pruritus of unknown origin represents a heterogeneous and poorly defined population, lacking clearly delineated mechanisms and FDA-approved therapies. He expressed hope that future research and pharmaceutical development will better characterize and target this broad group.

Ruiz Dasilva is also engaged in research examining heterogeneity in AD clinical trial design. He notes substantial variability in protocols, particularly regarding concomitant topical therapy use alongside systemic agents. This inconsistency complicates cross-trial comparisons in an era of expanding therapeutic options. He advocates for more standardized trial designs to facilitate meaningful comparisons without requiring numerous head-to-head studies.

Ultimately, Ruiz Dasilva encouraged clinicians to remain proactive and flexible, particularly for patients whose disease does not fit clean diagnostic “boxes.” By thoughtfully combining therapies and leveraging off-label strategies when appropriate, dermatologists can more effectively address persistent itch and refractory inflammation, prioritizing symptom relief and quality of life.

Reference

1. Del Rosso J, Ruiz Dasilva D. Optimizing treatment selection: a case‑based approach. Presented at: 2026 Winter Clinical Miami; February 27-March 1, 2026; Aventura, FL.