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Medical Dermatology

Skin Microbiome and Acne: Connecting the Dots

By | Medical Dermatology, Patient Care | No Comments
skin microbiome

When we think about skin, a few things come to mind: protection, temperature regulation, sensation. However, there is growing interest in the microbiome of the skin. Our skin flora can be likened to an invisible ecosystem. Similar to fingerprints, it is unique to each individual. The complexity of the skin microbiome is continuing to be researched. This research is paving the way to improve our understanding of the relationship between acne and dysbiosis.

At the GW Virtual Appraisal of Advances in Acne Conference, Dr. Adam Friedman discussed Microbiome Manipulation in the Management of Acne. His lecture provided insight on the microenvironment of the skin and how the diversity in skin flora can affect disease processes such as acne.

First, let me share a few pearls from Dr. Friedman’s lecture.

The skin is a physical barrier against invasion by pathogenic organisms and foreign substances. The skin is also an ecosystem, host to a variety of microorganisms that are typically harmless.

The habitat of the skin varies topographically and there are several factors that contribute to this unique variation among individuals.

The cutaneous immune system modulates and can be modulated by these commensal microorganisms. Dysbiosis, which directly refers to decreased microbial diversity, is directly linked to dysregulation of the skin immune response is evident in several skin disorders.

When we think about the skin barrier, we usually think about the hydrophilic corneocytes and hydrophobic lipids that make up this security guard for your skin. However, we do not necessarily think about the invisible barrier that protects the skin, which is composed of numerous microorganisms. Both of these components are vital to the structural stability of the skin barrier. If this invisible barrier is disrupted, this may lead to skin disease. Why are these commensal organisms so important?

Role of commensal organisms on the skin:

  • Inhibit colonization of foreign pathogens
  • Maintain the pH balance of the skin
  • Inhibit inflammation

We all have a unique skin microbiome. What contributes to the variability of the skin microbiome?

Factors contributing to individual variations in skin microflora:

  • Gender
  • Age
  • Environment
  • Lifestyle
  • Genetics
  • Underlying medical conditions

Read more….

Free Virtual Conference: GW Virtual Acne Appraisal Conference

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GW Virtual Appraisal of Advances in Acne

Hosted by George Washington University, in Partnership with ODAC Dermatology, Aesthetic & Surgical Conference and Next Steps in Derm

Even during a global pandemic we cannot forget that Acne Vulgaris is one of if not THE most common skin condition afflicting our patients and the general populace. With the disruption of clinics and conferences, innovative vehicles for the dissemination of the most up to date data and expert anecdote are certainly and sorely needed.

Enter the GW Virtual Acne Appraisal Conference: A 3 hour program that promises to pander to your pimple popping practices with short but sweet lectures from the acne gurus covering the gamut of the big A. From treatments to treats, from considering the microbiome to unique treatment approaches in specific patient populations, we will cover it all. And if that wasn’t enough, we will round it out with a perusal of the therapeutic pipeline. It will be all that and a bag of chips (which may or may not cause acne…you need to tune in to find out).

Agenda

8:00 – 8:15 – Introduction and Welcome
8:15 – Topical Management of Acne– James Q. Del Rosso, DO, FAOCD, FAAD
8:30 – Use of Hormonal Therapies in Acne– Julie Harper, MD
8:50 – Use of Antibiotics in Acne – Neal Bhatia, MD
9:10 – Issues with Isotretinoin: Fact vs. Fiction – Jenna C. Lester, MD
9:30 – Microbiome Manipulation for the Management of Acne – Adam Friedman, MD, FAAD
9:45 –  Diet and Alternative Therapies: What to know for Acne management – Vivian Shi, MD
10:00 – Management Considerations for Skin of Color Patients with Acne –Andrew Alexis, MD, MPH
10:20 – Managing Acne in the LGBTQ+ Population – Angelo Landriscina, MD
10:40 – New and Emerging Therapies for Acne – Leon Kircik, MD

View On-Demand: Starting Your Own Dermatology Practice: Expert Panel Discussion

By | Aesthetic Dermatology, Medical Dermatology, Patient Care, Video Pearls | No Comments

This webinar was previously recorded on July 1, 2020 and is now available on demand.

Hosted by ODAC
In Partnership with The Journal of Drugs in Dermatology
ODAC in partnership with the JDD, invite you to join your dermatology colleagues as we discuss strategies, steps and best practices for starting your own dermatology practice. Expert panelists will discuss their experiences with securing financing, choosing devices, hiring contractors and running a practice. They will give insights into what they wish they knew before beginning their practice, offer practical tips and much more!
MODERATOR
Aanand N. Geria, MD, FAAD (Founder, Geria Dermatology – Rutherford, NJ)
PANELISTS
Matthew J. Elias, DO, FAAD (Co-Founder, Elias Dermatology – Fort Lauderdale, FL)
Rishi K. Gandhi, MD, FAAD (CEO & Director, Ohio Skin Surgery and Cosmetic Center – Dayton, OH)
Chesahna Kindred, MD, MBA, FAAD (Founder, Kindred Hair & Skin Center – Columbia, MD)
Omar N. Qutub, MD FAAD (Founder, Dermatology By Design LLC – Portland, OR)

The Business of Dermatology: A Must Read

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The Business of Dermatology Cover Image

Business intellect, a vital aspect of managing a practice, is not taught in residency. From the infancy of their training, dermatologists are trained to think broadly and scrupulously, using each clue, each corporeal sense, and each available tool to accurately diagnose and manage a plethora of cutaneous conditions. After residency, dermatologists set out armed with the knowledge and drive to deliver expert care to their future patients. However, despite their education and best intentions, lack of business acumen can hinder even the brightest and most motivated of practitioners. In order to enlighten oneself in the complicated field of business management, clinicians are left to fend for themselves, often learning as they go, sometimes making unnecessary mistakes, and adjusting their business practices reactively. Retrospective “trial and error” learning is time-consuming, cumbersome, and costly. Why not short track and get the goods without the trial and error, making costly mistakes and taking years. The new book, The Business of Dermatology is a cornerstone achievement in the standardization of business education for dermatologists.

Edited by Drs. Jeffrey S. Dover and Kavita Mariwalla, and authored by impressive experts in the field, The Business of Dermatology offers a comprehensive guide to opening, maintaining, and sustaining a practice. To start, the power of this textbook fundamentally lies in the experience and scope of its authorship. The authors were hand-selected by the editors ensuring that each chapter was written by a tried and true expert in that subject. Unlike other textbooks in the field of business management and administration that are primarily written by individuals from the business world, some of whom have no insight into the inner machinations of the medical world, or hands-on experience, the authors of this book are well-known, respected dermatologists that hail from thriving practices of their own. The reader has an unprecedented opportunity to learn from the firsthand experiences of top authorities who live and breathe dermatology. Using conversational prose, the authors depict their experiences, trials, and errors, employing specific real-world examples and scenarios while tackling each subject.

A notable forte of The Business of Dermatology is the sheer breadth and range of topics discussed in the textbook by medical as well as surgical dermatologists. Opening and managing a practice is a daunting endeavor with twists, turns, and hidden hurdles that one cannot foresee until stumbling across them. The Business of Dermatology unveils those twists, turns, and hurdles for the reader, taking the “guessing game” out of the equation. Fifty-five chapters elucidate every aspect of running a practice, covering all practice-relevant topics, including office space and equipment, managing financials, diverse practice models, human resources, employment considerations, patient issues, pricing, essential surgical tools/supplies, marketing, and much more. The Business of Dermatology lays bare every facet of handling a dermatologic practice, so much so that even a well-run, seasoned practice stands to learn new tools and tips to elevate itself to a higher level.

And now more than ever in the “Time of Covid” we are in desperate need of information from The Business of Dermatology. Many of us are inventing the wheel with the significant changes that are occurring in Dermatology, and the practice of our specialty.

The wealth of knowledge endowed in each chapter is written and formatted in such a style that renders each chapter extremely easy to read and comprehend. First, the prose used in the chapters is conversational – as such, the reader is fully immersed in each topic as if he/she were having a face-to-face chat with the authors. Furthermore, references are used only when absolutely necessary. The reader is not bogged down by superfluous references and discussions that may dim the vital discussion points of the chapters. Finally, embedded within each chapter are practical tips that are immediately implementable and a Top Ten list that highlights the key take-home points, making “reading on the run” possible. The novice practice owner need not fear the residency dogma of “trying to drink from a gushing fire hydrant” with this easy-to-read, catchy and focused textbook.

Read More….

Dr. Adam Friedman Discusses 2021 ODAC Dermatology Conference Program

By | Aesthetic Dermatology, Medical Dermatology, ODAC Sessions, Patient Care, Surgical Dermatology, Video Pearls | No Comments

ODAC Dermatology, Aesthetic & Surgical Conference’s Medical Director, Dr. Adam Friedman, discusses the ODAC 2021 program, reasons to attend and more!

To view the full agenda, click here: https://orlandoderm.org/agenda/

ODAC Dermatology Conference is the premier clinical dermatology conference expertly curated to provide comprehensive, annual updates and fresh pearls in medical, aesthetic and surgical dermatology. Check out our blog and media coverage.
The 2021 ODAC dermatology conference focuses on new uses for old treatments, incorporating new treatments, products and treatment lines, critical updates in diagnosis guidelines, as well as advanced techniques for enhancing your surgical and nonsurgical patient outcomes.

Therapeutic Updates in Melanoma

By | Medical Dermatology, ODAC Sessions, Patient Care, Video Pearls | No Comments

ODAC Dermatology Conference, in partnership with Next Steps in Derm, interviewed Dr. David Miller, Instructor in Dermatology and Medicine at Harvard Medical School and member of the Department of Dermatology and the Department of Medicine at Massachusetts General Hospital, where he is co-director of the Merkel cell carcinoma treatment program. Watch as he shares important updates on Immuno-Oncology (IO) strategies for melanoma.

Melasma: Treatment Pearls from the Expert

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Next Steps in Derm, in partnership with ODAC Dermatology, Aesthetic and Surgical Conference, interviewed Dr. Vic Ross, Director of the Scripps Clinic Laser and Cosmetic Dermatology Center in San Diego, CA, on his approach and the various interventions he uses for the treatment of Melasma. Watch as he shares fresh practical pearls immediately useful in your practice.

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Hydroxychloroquine, Pentoxifylline, and Colchicine: Off-Label is ON in Dermatology

By | Medical Dermatology, ODAC Sessions, Video Pearls | No Comments

So many diseases, so few FDA approved indications. Between the mind-numbing time and cost from bench to bottle, it is no surprise that dermatologists, as masters of the integument are the off-label bandits, marrying their wealth of knowledge on the pathophysiology of skin diseases to the mechanisms by which medications work to create an evidenced-based armament of therapies for both common and rare diseases alike. Where a primary care physician sees a blood pressure medication, a dermatologist sees an effective medication for acne. A medication for malaria you say? They use it for a plethora of complex diseases ranging from Lupus to scarring hair loss. The lengthy list of medications used off-label in dermatology continues to grow and for good reason and fortune.

Next Steps in Derm, in partnership with ODAC Dermatology, Aesthetic and Surgical Conference interviewed Dr. Adam Friedman, Professor, Interim Chair of Dermatology, and Residency Program Director at George Washington University, who shared off-label uses of drugs such as Hydroxychloroquine (currently under investigation for the treatment of patients with COVID-19), Pentoxifylline, and Colchicine. A wealth of clinical pearls you don’t want to miss!

Additional video pearls can be found here.

Is COVID-19 an Indication to Temporarily Modify Dermatological Management Plans?

By | COVID-19 Resources, Medical Dermatology, Patient Care | No Comments
Coronavirus image

Source: Journal of Drugs in Dermatology

While the world lives under the shadow of the novel coronavirus (COVID-19) pandemic, dermatologists wonder if the current situation calls for a temporary change in the management of skin conditions.

Immunosuppressive drugs are used ubiquitously in the modern treatment of inflammatory and autoimmune skin diseases like psoriasis, bullous diseases, connective tissue diseases, and many others. Treatment of these conditions is based on the suppression of the patient’s immune system using steroids, steroid-sparing drugs, and biological agents.1

While the effects of the novel coronavirus on the body and its immune system are still being studied, there is overwhelming evidence that the virus could directly or indirectly affect the immune system. In one study, lymphocytopenia was reported in 83.2% of the admitted patients and might be associated with a worse prognosis.2In another study, a steady decline in the lymphocyte counts was recorded in a group of patients who did not survive the infection.3

While the coexisting comorbid medical conditions (such as diabetes or heart disease) are considered as independent predictors of an adverse outcome of the novel coronavirus infection,4 it could be assumed that the chronic inflammatory and autoimmune skin diseases like psoriasis by themselves might imply an additional risk factor of developing more serious symptoms of the novel virus due to their chronicity and effects on the immune system.5

The use of immunosuppressive to treat these conditions can amplify this effect, and it might leave the patient vulnerable to more serious complications should an infection with the novel coronavirus be established. Hence, it may be wise to restrict temporarily the use of immunosuppressive agents including systemic steroids, steroid-sparing agents, and biologics in dermatology daily practice until more evidence is available about their safety in the current pandemic.6As a relates point, the International Psoriasis Council declared an urgent statement on March 11, 2020 that the physician should be alert to the potentially harmful effects of COVID-19 infection on patients with psoriasis and to immediately discontinue or postpone immunosuppressant medications for psoriasis patients diagnosed with COVID-19 disease.7

Read More….. 

Clinical Photography: Pearls from the ODAC Dermatology Conference

By | Medical Dermatology, ODAC Sessions, Video Pearls | No Comments

Clinical photography is a critical tool for the dermatologist and has rapidly become standard of care in the digital era.  While a point-and-click approach to photography is sufficient for some circumstances, there are some simple tricks and techniques that will elevate your photography to a new level of professionalism.

Next Steps in Derm, in partnership with ODAC Dermatology, Aesthetic and Surgical Conference interviewed Dr. Justin Finch, Associate Professor of Dermatology at UConn and Co-Founder of Central Connecticut Dermatology who shared his top 3 pearls for improving clinical photography in your practice.

Read More…..