Derms on Drugs

Thin melanomas that behave badly, a surprisingly intriguing role for oxybutynin in HS, and a reminder that some of dermatology’s most trusted assumptions deserve a second look. This week’s 6-pack is all about the exceptions that force us to rethink the rules.

The diagnoses get messy, the treatment decisions get interesting, and the DoD crew has opinions. From a major scabies study to a practical overlap-disease pearl, this week's episode is full of reminders that dermatology is rarely as straightforward as it seems.

An emerging infection out of France, a surprisingly clever vitiligo combo, and a spirited debate about whether medicine has ever actually cured anything. Just another normal week on Derms on Drugs.

Melanoma, Anxiety, and Depression Links; Biosimilars vs Humira; Air Pollution and Atopic Dermatitis – Have We Finally Figured Out Why Eczema Is So Common and much, much more… 
Which patients are the most affected by anxiety and depression after a melanoma diagnosis and what can we do about it?
Patients who are switched onto a biosimilar do “worse” than patients who start one as their first therapy – why?
We finally got eczema answers.  Turns out that air pollution, both indoor and outdoor, is the cause of the atopic dermatitis epidemic that started in the 1970s and is why eczema is more common in urban areas.
Ian Myles explains how he proved that air pollution is the driving force behind atopic dermatitis and helps our team understand what it all means  
Plus: Predictors of acne relapse after isotretinoin, dupilumab prevents cancer, how well does tralokinumab work in dupilumab "failures," ferulic acid for rosacea, cysteamine vs hydroquinone for melasma, and the best way to treat digital mucous cysts
Guest: Ian A. Myles, MD, Mph 
Dr. Myles,  Principal Investigator, Epithelial Therapeutics Unit, graduated with a B.S. in biology from Colorado State University in 2001 and then obtained an M.D. from the University of Colorado in 2005. He completed an internal medicine residency at The Ohio State University prior to beginning fellowship training in allergy and clinical immunology at NIH. He worked under the mentorship of Dr. Sandip Datta investigating the mechanistic details of susceptibility to S. aureus skin infections. In 2011, Dr. Myles became a commissioned officer in the United States Public Health Service Commissioned Corps. LCDR Myles has supported several USPHS missions, from the Ebola virus vaccine trial in West Africa to congressional Gold Medal Ceremonies at the U.S. Capitol. In 2013, he was awarded a position as an assistant clinical investigator in the NIAID Transition Program in Clinical Research. Dr. Myles received his M.P.H. from George Washington University in 2016. In 2018, Dr. Myles became the head of the newly formed Epithelial Therapeutics Unit to evaluate the efficacy and safety of a topical, live bacterial treatment for atopic dermatitis (eczema). He is currently a participant in the Lasker Clinical Research Scholars and Distinguished Scholars programs.

Psoriatic arthritis usually gets explained in a way that makes derms want to leave the room. Not this episode. Drs. Zirwas, Ferris, and Patton are joined by double-boarded rheum-derm expert Dr. Saakshi Khattri for a practical, entertaining deep dive into recognizing PsA and making smarter treatment decisions — without the rheumatology overload.