60 Tips in 60 Minutes: Day 1 at the 2025 Midwinter Clinical Hawaii Dermatology Conference 

Tip #1 Neal Bhatia, MD
Rosacea patients want natural treatments: Rosacea patients want natural treatments: options include •Aloe vera – soothing qualities, antioxidant, antimicrobial, and anti-inflammatory actions, inhibits bacterial protein synthesis •Licorice extract - Glycyrrhiza glabra L. and Glycyrrhiza inflata L •Rich in flavonoids and saponins •Licochalcone A in cream twice daily for 3 days decreased the amount of erythema caused by shaving and UV exposure when compared with a vehicle control.

Tip #2 Clay J Cockerel, MD
BEWARE of Relying on Margin Status on Shave Biopsy: •Margins on shave biopsies NOT equivalent to elliptical or Mohs excisions •Cannot evaluate deep periphery of specimen or exclude extension down follicles •Pathologist should NEVER say that it has definitely been completely removed – 30% or higher recurrence rate • NEVER rely on for melanoma in any form

Tip #3 Cheri Frey, MD
Procedural use of Tranexamic Acid: •Safety/efficacy of TXA evaluated in double-blind placebo controlled randomized prospective study, 131 participants •Lidocaine 2% diluted 1:1 with either saline or TXA 100 mg/1 mL before surgery •Bloodstain to surgical wound size ratio was smaller in TXA vs placebo group (P <.001); improved effect of TXA on bleeding observed in subgroup on anticoagulants (P <.001) •Conclusion: SC injection of TXA was safe, reduced bleeding during dermatologic surgery, and particularly effective taking anticoagulants

Tip #4 Mark Lebwohl, MD
Oral fluconazole for candida in patients with psoriasis: •Research demonstrates successful use of oral fluconazole for moderate to severe oropharyngeal candidiasis, 100–200 mg (3 mg/kg) daily for 7–14 days recommended •Case study2 of 52 y/o woman with recurrent vulvovaginal candidosis and PsA: Failed MTX, adalimumab and etanercept in combination with MTX, ustekinumab + apremilast, deucravacitinib •Treated with fluconazole – induction 150 mg 3x/week, then weekly 150 mg for 6 mos •Pessaries: 100 000 IU nystatin 14 nights, 600 mg boric acid 14 nights

Tip #5 Neal Bhatia, MD
Topical hypericin gel (SGX301) + visible light PTD for CTCL. •SGX301 photodynamic agent induces apoptosis in B and T cells •Effective in phase II study in early stage MF/CTCL with nb-UVB •16% index lesion response rate at 8 weeks (vs 4% placebo, P <.04) 40% at 16 weeks, 49% at 24 weeks •SGX301 vs topical nitrogen mustard: efficacy shown across studies with different treatment durations