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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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Atopic Dermatitis Cases & Board Pearls: Eczema Herpeticum/Kaposi’s Varicelliform Eruption, Infection Management, and the Atopic March | The Derm Resident

Host dermatology resident Jonny Hatch and Dr. Peter Leo finish an atopic dermatitis episode with cases and board-focused pearls. They review recognition and urgent management of eczema herpeticum (crusted, punched-out lesions), emphasizing HSV PCR/culture, considering bacterial coinfection, empiric antivirals (valacyclovir/acyclovir) and when IV acyclovir/hospitalization is warranted, plus Tzanck smear and biopsy findings (three Ms). They discuss Kaposi’s varicelliform eruption etiologies including eczema coxsackium (supportive care, possible empiric antiviral while ruling out HSV, and onychomadesis) and a life-threatening eczema vaccinatum story. They cover the atopic march, transcutaneous sensitization, LEAP study implications, and why most eczema doesn’t improve with dietary restriction. Practical guidance includes treating impetiginized AD with drying compresses and topical mupirocin, limited oral antibiotics, updated views on bleach baths, bathing frequency, topical steroid potency by vehicle, dupilumab-associated conjunctivitis theories, IL-31-mediated itch, TSLP signaling, site-specific steroid absorption, and why JAK1 selectivity matters.

00:00 Podcast Intro
00:19 Eczema Herpeticum Case
02:04 Testing and Swabs
03:09 Empiric Treatment Plan
04:05 When to Hospitalize
05:27 Tzanck Smear Basics
06:53 Eczema Coxsackium Overview
07:33 Kaposi Varicelliform Story
10:21 Differentiating Coxsackium
11:32 Atopic March Explained
13:56 Diet and Food Allergy Myths
18:13 Bacterial Superinfection Case
20:11 Topicals and Tea Compresses
21:13 Bleach Baths Reality Check
22:01 Topicals Over Orals
23:50 Bleach Baths and Bathing
27:23 Eczema Herpeticum Drill
28:20 Steroid Potency Vehicles
29:11 Dupilumab Eye Effects
31:22 Itch Pathways Explained
32:22 Eczema Coxsackium Care
34:58 Atopic March TSLP
36:42 Steroid Absorption Sites
37:30 Genital Itch Strategy
39:49 JAK STAT6 and Future
41:41 Wrap Up and Thanks

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Atopic Dermatitis Treatment Ladder: Moisturizers, Topical Steroids, Nonsteroidals, Biologics, and JAK Inhibitors (with Dr. Peter Lio) | The Derm Resident

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Host dermatology resident Jonny Hatch interviews Dr. Peter Lio about atopic dermatitis treatment, emphasizing moisturizers (prescriptive product guidance, National Eczema Association Seal of Acceptance, ointments/petrolatum for stinging) and topical corticosteroid selection by potency, vehicle, and body site, with counseling on rare but important adverse effects and steroid stewardship. They distinguish tachyphylaxis from topical steroid withdrawal, noting evolving recognition and potential mechanistic clues. The episode reviews nonsteroidal topicals (tacrolimus/pimecrolimus counseling, black box warning context, stinging mitigation, crisaborole limitations, roflumilast benefits/rare diarrhea, topical ruxolitinib efficacy and boxed warning counseling), then escalates to systemic therapy with phototherapy, biologics (dupilumab, tralokinumab, lebrikizumab, nemolizumab), and oral JAK inhibitors (upadacitinib, abrocitinib) including risks and lab monitoring. They also discuss limited roles for antihistamines, the Dr. Aron regimen compound, and phage-lysin anti-staph products, and preview part two.

00:00 Welcome and Guest Intro
00:51 Moisturizers as Foundation
02:45 Choosing Eczema Safe Products
05:27 Ointments for Sensitive Skin
07:07 Topical Steroid Ladder Basics
08:43 Potency Picks and Stewardship
11:18 Monitoring Steroid Side Effects
12:45 Eyelids and Steroid Sparing
14:19 Tachyphylaxis vs TSW
17:23 Steroid Mechanism of Action
18:51 Calcineurin Inhibitors Counseling
22:42 Eucrisa and PDE4 Reality Check
24:07 Roflumilast Practical Use
25:59 Topical JAK Inhibitor Opzelura
28:43 Placebo and Adherence
29:14 When to Escalate Care
29:41 Biologics Treatment Targets
31:57 ADCT Control Scoring
32:45 Insurance Documentation Tips
33:24 Dupilumab Side Effects
34:15 Managing Eye Symptoms
36:13 Head and Neck Flares
37:37 Switching Biologics Strategy
39:32 Nemolizumab Itch Control
40:00 Oral JAK Inhibitors Overview
41:45 Black Box Risk Counseling
44:36 Lab Monitoring Schedule
46:13 Antihistamines Reality Check
47:51 Aaron Regimen Compound
51:53 Bacteriophage Spray Future
53:42 Closing and Next Steps

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Atopic Dermatitis High-Yield Review: Etymology, Diagnosis, Pathogenesis, Cytokines, Microbiome, Distribution, and Mimickers | The Derm Resident

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Hosts Dr. Jonny Hatch and Dr. Deven Curtis review high-yield atopic dermatitis (AD), covering its 1923 “atopos” etymology, clinical definition, and the atopic march (AD/food allergy in infancy, asthma in childhood, allergic rhinoconjunctivitis in adolescence). They outline AAD diagnostic criteria: pruritus, classic age-specific morphology/distribution, and chronicity, plus intrinsic (IgE-associated) vs non–IgE AD. Pathogenesis is framed as barrier dysfunction, immune dysregulation, and microbiome alteration, highlighting filaggrin’s role, transepidermal water loss, increased skin pH, and unchecked kallikrein proteases; Netherton syndrome (SPINK5/LEKTI) is discussed. They review Th2→Th1 evolution, key cytokines (IL-4/13 targeted by dupilumab; IL-13-only agents; IL-31 “itch cytokine” and nemolizumab), Staph aureus colonization and impetiginization, age-based distribution patterns, site variants and stigmata (Denny-Morgan lines, white dermatographism, keratosis pilaris, ichthyosis vulgaris), complications (ocular disease, eczema herpeticum with IV acyclovir on boards), quality-of-life impact, biopsy rationale (spongiotic dermatitis, rule out mycosis fungoides), and common mimickers and differentials including seb derm, scabies, contact dermatitis, immunodeficiencies, hypereosinophilia causes, nummular dermatitis, SCC in situ, dyshidrotic eczema, and asteatotic eczema.

00:00 Welcome and Topic Setup
00:31 Atopic Derm Name Origin
01:59 What It Is and Atopic March
04:41 Diagnosis Criteria Essentials
06:13 IgE Types and Core Pathogenesis
08:32 Barrier Breakdown and Filaggrin
13:02 Proteases and Netherton Syndrome
15:11 TH2 to TH1 Cytokine Shift
18:09 Dupilumab IL4 IL13 Explained
21:24 IL31 The Itch Cytokine
23:57 Staph Aureus and Microbiome
27:10 Age Based Distribution Infants
27:53 Age Based Distribution
29:32 Site Specific Variants
31:18 Head Neck Dupixent
31:58 Atopic Stigmata Signs
34:24 Ichthyosis And KP
36:09 Ocular Complications
37:55 Eczema Herpeticum Urgency
40:07 Quality Of Life Burden
42:27 When To Biopsy
45:18 Mimickers And Immunodeficiency
49:31 Eosinophilia Differential
50:22 Rapid Fire Dermatitis
53:25 Episode Wrap Up

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Rosacea High-Yield Review: Subtypes, Triggers, Treatment Ladder, and Key Differentials (with Dr. Anuj Kunadia) | The Derm Resident

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Link to Rosacea Sketches

Dr. Jonny Hatch welcomes Dr. Anuj Kunadia, founder of DermatoGraphix, to review high-yield rosacea. They distinguish rosacea from acne by the absence of comedones and discuss subtypes: erythematotelangiectatic (erythema/telangiectasias, burning/stinging; often procedural treatment with PDL or IPL), papulopustular (topicals like azelaic acid, metronidazole, ivermectin; oral low-dose doxycycline; isotretinoin if refractory), phymatous (sebaceous hyperplasia/fibrosis; rhinophyma and other “phyma” sites; early isotretinoin vs surgical/laser debulking), and ocular (can precede skin findings; refer to ophthalmology and consider doxycycline). They cover pathogenesis including kallikrein-5/cathelicidin LL-37, Demodex association and ivermectin, common triggers, variants (granulomatous rosacea, rosacea fulminans, Morbihan disease), key differentials (seborrheic dermatitis, lupus), periorificial dermatitis management (stop steroids, pimecrolimus/doxycycline), and conclude with rapid-fire boards questions and an art-history rhinophyma example.

00:00 Welcome and Setup
00:19 Meet the Guest
00:44 Dermatographics Origin
01:52 Classic Rosacea Case
02:30 Rosacea Basics
03:08 Acne vs Rosacea
04:21 Rosacea Subtypes
04:49 ETR Features and Lasers
05:58 Pathogenesis and Demodex
08:55 Triggers and Photoprotection
11:46 Phymatous Rosacea
13:41 Ocular Rosacea Red Flags
15:15 Rare Rosacea Variants
19:34 Key Differentials
23:19 Treatment Ladder Overview
24:23 Topicals for Redness
26:19 Papulopustular Treatments
30:19 Procedures for Rhinophyma
31:03 Periorificial Dermatitis
34:29 Periorificial Treatment Plan
35:47 Rapid Fire Boards Quiz
41:01 Fun Fact and Wrap Up

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Acne & Rosacea Pearls with Dr. John Barbieri: Diagnosis, Antibiotics, Isotretinoin Dosing, and Pregnancy-Safe Options | The Derm Resident

In this “Meet the Expert” episode of The Derm Resident, Dr. Jonny Hatch talks with acne and rosacea expert Dr. John Barbieri about practical, early-resident approaches to acne and common mimickers, emphasizing comedones as a key differentiator and reviewing clues for periorificial dermatitis, rosacea, and pityrosporum folliculitis. They discuss why “jawline acne” is not a strong predictor of PCOS/PMOS and why signs like irregular menses, hirsutism, and acanthosis nigricans are more informative. Dr. Barbieri outlines systemic treatment decision-making, favoring spironolactone over long-term antibiotics in many patients, and reviews antibiotic choices and resistance concerns. The conversation then covers isotretinoin timing, dosing to clinical endpoints, adjuncts to reduce flaring and side effects (loratadine, omega-3, L-carnitine), counseling on growth and mood risk, pregnancy-safe acne options, benzoyl peroxide/benzene concerns, rosacea redness treatment (oxymetazoline), and common trainee mistakes.

00:00 Welcome and Guest Intro
00:42 Acne Exam Basics
01:08 Acne Mimickers
02:36 History and PCOS Clues
03:30 Jawline and Hormones
05:26 Systemic Treatment Choices
07:01 Low Dose Doxy Debate
08:59 Antibiotics as Bridge
10:59 Which Antibiotic to Pick
13:35 Starting Isotretinoin (Accutane)
15:46 Dosing and Endpoints
17:32 Cumulative Dose Myths
19:17 Higher Daily Dosing
20:12 Antihistamine Add On
21:09 Omega 3 For Dryness
22:25 L Carnitine For Soreness
23:42 Growth Stunting Myth
24:33 Mood And Suicide Risk
27:02 Acne In Pregnancy
28:09 Topical Combo Strategies
29:23 Benzoyl Peroxide and Benzene
30:41 Resident Mistakes And Rosacea
33:18 Rosacea Phenotype Approach
34:52 Advice For New Residents
35:30 Final Thanks And Wrap

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