5 Final Dermatology Tips from the Midwinter Hawaii Dermatology Conference

Tip for treating acne/postinflammatory hyperpigmentation: •Doxycycline 100mg BID x 1 month •1726nm laser (targets sebaceous glands) every 4 weeks for3treatments•Significant improvement •Followed by 4% hydroquinone with remarkable results.

Read more: Alexaides M, et al. Novel 1726 nm laser demonstrates durable therapeutic outcomes and tolerability for moderate-to-severe acne across skin types. J Am Acad Dermatol. 2023;89(4):703-710. doi: 10.1016/j.jaad.2023.05.085

Is it a flare or is eczema/psoriasis getting worse? If it's flare, start with topicals •TCS, TCI, vit D analogue, retinoid, roflumilast, tapinarof) •Use phototherapy: 308 nm Eximer/XTRAC•“Mini” load with sample •PsA: Add DMARD or synthetic (apremilast)

If eczema or psoriasis is getting worse, not just a flare, consider either primary or secondary treatment failure and adjust therapy as appropriate either staying in the same class of medication or switching classes.

For actinic keratosis, don't forget the 5FU: cheap, effective, but not easy. •No pain, no gain: 30 day twice daily vs pulse vs 5-FU/calcipotriene 5/7 for 1 week on, 2 weeks off and repeat if still rough for 2 cycles •30-day: Therapy for facial AKs and microscopic cancer foci •60-day+: scalp, arms, trunk

Issues in photoprotection for skin of color: •Lower range of visible light (VL) primarily responsible for inducing pigment in darker skin types •Mineral sunscreens (metal oxide protection) protect against visible light but tend to leave white cast on skin of color = aesthetically unpleasing

Read more: Rigel DF, et al. J Am Acad Dermatol. 2022;86(3S):S1-S8. doi: 10.1016/j.jaad.2021.12.019

Tips on effective photoprotection for skin of color: •Tinted sunscreens provide optimal protection against VL •Provides both protection and aesthetic properties needed for skin of color, no white cast •Recommended formulations contain iron oxide, titanium dioxide, zinc oxide

Read more: Song H, et al.Int J Womens Dermatol. 2020 Nov 10;7(2):165-170. doi: 10.1016/j.ijwd.2020.10.008. Dumbuya H, Grimes PE, et al. J Drugs Dermatol. 2020;19(7): doi:10.36849/JDD.2020.5032

Remember your heb B serology: Biologic therapies pose minimal risk for viral reactivation in low-risk patients without hepatitis seropositive for HCV or HBV core antibody but pose a considerable risk in patients with chronic HBV infection •Antiviral prophylaxis is indicated

Read more: Snast I, Atzmony L, Braun M, Hodak E, Pavlovsky L. J Am Acad Dermatol. 2017 Jul;77(1):88-97.e5. doi: 10.1016/j.jaad.2017.01.037. Navarro R, Vilarrasa E, Herranz P, et al. Br J Dermatol. 2013;168:609-616. Pompili M, Biolato M, Miele L, et al. World J Gastroenterol: WJG. 2013;19:7867-7873.

How to approach hep B during dermatologic treatment with biologics: History of or active Hep B: May receive biologic after evaluation/clearance with hepatologist •May require anti-viral •Core Ab test recommended. History of confirmed resolved Hep B: Do not need to see specialist •Recommend close laboratory follow up as reactivation is possible

Read more: Menter A et al. J Am Acad Dermatol. 2019 Apr;80(4):1029-1072. doi: 10.1016/j.jaad.2018.11.057. Kaushik SB, Lebwohl MG. J Am Acad Dermatol. 2019 Jan;80(1):43-53. doi: 10.1016/j.jaad.2018.06.056