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Psoriasis Part 2: Differentials, Psoriatic Arthritis Screening, and the Psoriasis Treatment Ladder | The Derm Resident

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Hosts Dr. Jonny Hatch and Dr. Deven Curtis continue psoriasis with a focus on chronic plaque differentials, psoriatic arthritis, and a practical treatment ladder. They review mimickers including seborrheic dermatitis and lichen simplex chronicus (including “sebo-psoriasis”), mycosis fungoides prompting biopsy when plaques are treatment-resistant or atrophic, hypertrophic lichen planus on shins, and guttate-pattern differentials such as pityriasis rosea, pityriasis lichenoides chronica, and secondary syphilis. They emphasize screening for psoriatic arthritis (about one-third of patients; HLA-B27 association) using joint/back pain history, nail findings, and dactylitis, with rheumatology referral when appropriate. Treatments covered include topical steroids by site, calcipotriene, tazarotene, roflumilast foam, tapinarof, phototherapy (narrowband UVB preferred over PUVA), and systemic therapies (methotrexate with folate, cyclosporine, apremilast, acitretin) plus biologics (TNF, IL-17, IL-23, ustekinumab) and deucravacitinib, along with biologic prescreening (TB, hepatitis, CBC/CMP, vaccine counseling) and psoriasis comorbidity risks.

00:00 Show Intro and Disclaimer
00:29 Plaque Psoriasis Differentials
02:21 Guttate Mimickers
03:25 Screening for Psoriatic Arthritis
04:53 Topical Treatment Basics
06:32 Nonsteroid Topicals and New Agents
08:13 Phototherapy UVB and PUVA
10:45 Systemics Methotrexate Deep Dive
13:45 Cyclosporine and Oral Options
18:11 Biologics TNF Alpha Inhibitors
22:41 IL-17 Inhibitors Key Pearls
25:47 IL-23 and IL-12/23 Therapies
28:23 Deucravacitinib and Biologic Workup
30:46 Psoriasis as Systemic Disease
31:32 Closing Pearls and Wrap Up

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Psoriasis High-Yield Review (Part 1): Epidemiology, Immunopathogenesis, Triggers, and Clinical Variants | The Derm Resident

Hosts Dr. Jonny Hatch and Dr. Deven Curtis review psoriasis for residents, covering historical confusion with leprosy, prevalence (about 2% worldwide; higher in the US/Canada), bimodal onset (20–30 and 50–60), and systemic burden including psoriatic arthritis and comorbid metabolic, cardiovascular, and mood disease. They discuss genetics (notably HLA-Cw6 at PSORS1) and modern immunopathogenesis centered on the IL-23/Th17/IL-17 axis, including keratinocyte–immune “vicious cycle,” neutrophilic histology (Munro microabscesses, spongiform pustules of Kogoj), and TNF’s broad role. The episode reviews disease memory, Koebner phenomenon, triggers (strep, stress, HIV, hypocalcemia, pregnancy, key medications), lifestyle associations, classic plaque features and signs (Auspitz, Woronoff), PASI scoring, and variants including guttate, erythrodermic, and pustular psoriasis (IL36RN/DITRA; spesolimab), plus scalp, inverse, nail, and rare mucosal involvement.

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00:00 Show Intro and Disclaimer
00:36 Psoriasis History Origins
02:06 Epidemiology and Onset
03:23 Systemic Burden Comorbidities
04:22 Genetics and HLA CW6
06:38 Modern Immune Model
08:43 Trigger to T Cell Cascade
12:02 Th17 Cytokines and Plaques
15:08 IL 23 Th17 Axis Explained
18:20 Histology Neutrophils and TNF
20:48 Disease Memory and Koebner
22:36 Triggers Infections Drugs Lifestyle
27:19 Plaque Psoriasis Clinical Exam
30:10 PASI Score Made Simple
32:37 Guttate and Erythrodermic Types
35:40 Pustular Variants and Genetics
40:11 Special Sites Nails Mucosa
42:14 Wrap Up and Part Two

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Chronic Pruritus Workup & Treatment Pearls (CPUO, Neuropathic Itch, Nemolizumab, JAKs) | The Derm Resident

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Dr. Jonny Hatch hosts Dr. Diego Da Silva, a chronic pruritus expert and host of Skin In the Game, to discuss a practical approach to itch. They outline an initial framework based on distribution (localized vs generalized), time course (with shorter duration and older age raising concern for malignancy), and morphology (primary lesions vs excoriations only). For localized itch without rash, they emphasize neuropathic etiologies (notalgia paresthetica, brachioradial pruritus, meralgia, dysesthesias), consider spine wear-and-tear, and discuss PT plus gabapentinoids and other neuromodulators. For generalized pruritus without rash, they review ROS for constitutional symptoms, recommend considering biopsy of “normal” itchy skin (e.g., CTCL, sarcoid), and suggest labs (CBC, CMP, TSH, A1C, SPEP/IFE, ferritin, vitamin D), chest X-ray, and BP testing/DIF. Treatment pearls include skincare, phototherapy, atopic-directed therapies (dupilumab, nemolizumab), JAK inhibitor counseling (noting shingles risk and “JAKne”), and empiric ivermectin for possible scabies; off-label options include low-dose naltrexone, dronabinol, and intranasal butorphanol, plus advice for residents to develop a niche and “declare” expertise.

00:00 Show Introduction
00:59 Why Itch Matters
01:26 Finding a Niche
04:44 First Steps in Pruritus
07:00 Localized Itch Workup
09:02 Neuropathic Itch Treatments
11:32 Generalized Itch Workup
14:32 Labs Imaging and Biopsy
17:54 Treating CPUO Like Atopy
21:49 Choosing First Biologic
22:27 Nemolizumab Itch Breakthrough
23:58 JAK Inhibitors Safety Reality
26:08 Managing Shingles And Jackne
28:05 Treating Jackne Options
28:54 Derms As Real Doctors
30:54 Low Dose Naltrexone Role
32:15 Scabies And Empiric Ivermectin
33:09 Off Label Itch Rescue Meds
35:42 Advice And Podcast Wrap Up

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