Derms on Drugs – Episode Summary

Podcast: Derms on Drugs
Host: Scholars in Medicine
Episode: Derm Literature Lightning Round: New Insights, Big Impact
Air Date: September 12, 2025
Panel: Dr. Matt Zirwas, Dr. Laura Ferris, Dr. Tim Patton
Special Guest: Dr. Scott Drew

Brief Overview

This "Derm Literature Lightning Round" episode delivers a rapid-fire review of recent, impactful studies and hot topics in dermatology, with panelists sharing practical takeaways, expert critiques, and characteristic banter. Joined by Dr. Scott Drew, the team examines pediatric eczema prevention, sunscreen ingredient regulation, cutting-edge therapies, and new device innovations, offering both clinical pearls and honest skepticism for dermatology professionals. As always, the hosts mix insights with humor, making complex dermatology literature accessible and engaging.

Key Discussion Points & Insights

1. Emollients to Prevent Pediatric Eczema: The CASCADE Trial

Article discussed: JAMA Dermatology – Can moisturizing infants every day prevent eczema?

• Study Summary:
  • Large, US-based randomized trial (1,247 infants, 25 clinics)
  • Daily application of emollient started before 9 weeks of age
  • Outcome: By age 2, 36% in moisturizer group developed atopic dermatitis vs. 43% control
  • Relative risk reduction: 6.9% (Number Needed to Treat = 15)
• Nuanced Findings:
  • Greatest benefit in babies without a family history of eczema and those with dogs at home
  • Stringent "UK Working Party" diagnostic criteria showed little difference between groups
  • Parent-reported cases inflated prevalence (up to 40%), raising concerns about diagnostic rigor
• Critiques:
  • Unusually high reported incidence questions generalizability
  • Most past studies showed no benefit; possibly a statistical anomaly
• Clinical Implication:
  • No harm in moisturizing, but "we’re barking up the wrong tree" for prevention
  • Most meaningful for parents already motivated, but little impact for high-risk families

Memorable quotes:

• Dr. Laura Ferris:
  "I could just give out moisturizers and puppies to everybody—it would be a lot more fun!" [02:00]
• Dr. Matt Zirwas:
  "There are a lot of derms out there...who really, really, really want it to be the case that moisturizing babies prevents eczema. So far, the data hasn’t shown it." [04:34]
  "If you do enough studies, eventually one’s going to randomly show benefit." [05:10]

2. Modernizing U.S. Sunscreen Regulations

Article: Turner et al., Photodermatology, Photoimmunology, and Photomedicine (June 2025)

• Key points:
  • U.S. sunscreens categorized as OTC drugs; Europe and Asia as cosmetics, leading to slower approval for new filters in the U.S.
  • New agents (e.g., bemotrizinol/Tinosorb S, bisoctrizole) offer broad-spectrum protection, minimal skin absorption, no endocrine disruption, and high cosmetic acceptability.
  • These ingredients widely used abroad and may soon become available in the U.S.
• Regulatory Frustration:
  • Panel notes excessive regulatory barriers prevent superior products from U.S. market
• Wider Health Impact:
  • Dr. Drew highlights danger of heavy metals in unregulated "whitening" creams in Africa, underlining importance of safe, effective OTC products globally

Memorable quotes:

• Dr. Tim Patton:
  "Something that is cosmetically acceptable is going to be used by the patients. It’s kind of crazy that the U.S. has the system it has..." [10:30]
• Dr. Laura Ferris:
  "Is this our hill to die on as dermatologists? We have sunscreens that work...we have such bigger fish to fry." [11:34]

3. Lightning Round: Quick Hit Research Updates & Insights

a. Immune Checkpoint Inhibitor Reactions

• Findings:
  • Eczematous and lichenoid eruptions following checkpoint inhibitors are TH2-driven—not the expected TH1
  • Histology alone may NOT indicate immune pathway; clinical response to Dupilumab supports TH2 role

Quote:

• Dr. Matt Zirwas:
  "If you get lichenoid and a hint of spongiosis—go with spongiosis." [15:25]

b. Alopecia Areata: Adjunctive Treatments

• Mini-pulse corticosteroids can be effective as monotherapy or adjunct to JAK inhibitors
• Steroid occlusion (e.g., clobetasol under swim cap) can “kickstart” response to JAKs
  • Regain, then maintain with JAK alone

c. Cerave vs. "Regular" Moisturizer

• Study:
  • Cerave arm more resistant to barrier disruption (tape stripping, sodium lauryl sulfate) despite similar water loss scores
  • Clinical implication: Not all moisturizers created equal; Cerave may offer more robust protection.

d. JAK Inhibitors: Cardiovascular Risk Signal

• First database study showing increased DVT and PE risk for JAKs vs. dupilumab/methotrexate/cyclosporine
• Takeaway: Now evidence both for and against risk exists; cannot say “no studies” show harm

e. Trelo (Tralokinumab) vs. Lebri (Lebrikizumab) for Dupilumab-Induced Arthralgia

• Case series: Tralokinumab may be preferable in patients who develop arthralgias on Dupilumab; Lebri still may cause arthralgias in a minority.
• Mechanistics: Subtle differences in IL-4 signaling blockade theorized, but not conclusive.

Quote:

• Dr. Zirwas:
  "I now have a reason to say—if you’re the one in 200 who get significant dupy arthralgias and I want to keep you on an IL-13 targeting drug, I’m probably going to choose Trelo." [21:07]

4. Innovative Devices & Home Treatments

a. Resell (RECELL) for Vitiligo

• Multi-center study: Device allows quick autologous cell harvesting & transfer for stable vitiligo (minimally invasive “melanocyte smoothie” vs. punch grafts)
• Results:
  • ~2/3 got >50% repigmentation; 42% >80%, only 8% achieved full repigmentation
  • High satisfaction (72% patients, 84% clinicians)
• Pairing: Combined with NB-UVB for maintenance/enhanced effect
• Practical Impact: Makes surgical therapy feasible for “average” dermatologist

Quote:

• Dr. Ferris:
  "It makes it technically easy for the average dermatologist…a smooth cell suspension right...makes it more accessible..." [25:17]

b. Intralesional Triamcinolone Self-Injection Device for Acne

• Study: At-home device as effective as in-office
• Skepticism:
  • Panel unconvinced about real-world safety/logistics; concern for atrophy/dents if overused or improperly dosed

Quote:

• Dr. Ferris:
  "I can't imagine putting this in the hands of patients." [28:18]

5. Micro-Pearls & Clinical Nuggets

1. Sentinel Node Biopsy Allergies:
   • Patent blue V or isosulfan blue dyes can cause reactions; methylene blue is a safer alternative [29:21]
2. Burning Mouth Syndrome:
   • Balsam of Peru allergy? Consider a diet low in tomatoes, spices (inc. vanilla/chocolate), citrus [29:31]
3. Erythema Nodosum:
   • Apremilast shown effective—add to the armamentarium [30:49]
4. Frontal Fibrosing Alopecia:
   • Topical latanoprost (Latisse) reported to stabilize/slightly improve; evidence still weak [30:57]
5. Cheilitis Granulomatosa:
   • Kenalog injection + oral metronidazole effective for stubborn cases [32:04]
6. Hidradenitis Suppurativa (HS):
   • Metformin or SGLT2 inhibitors halve mortality risk; likely due to reducing systemic inflammation [32:31]
   • Metformin is "much safer" than doxycycline; do not fear GI side effects (minimal at standard doses)
   • Should be considered adjunctive, not sole therapy

Quote:

• Dr. Zirwas:
  "Metformin is a much safer drug than doxycycline. Like, much safer." [33:30]
• Dr. Drew:
  "Those patients are so desperate and they have been misinformed for so long...this would be a well-received agent." [34:31]

Notable Quotes & Memorable Moments

• Dr. Ferris (on dogs and eczema): "Maybe we’re barking up the right tree with getting everybody a dog." [05:34]
• Dr. Drew (on dermatologists as care coordinators): "The skin person—the four of us and all of our colleagues—are the people that should be the home of this disease management...This is a science-based disease." [07:25]
• Dr. Patton (on sunscreen regulation): "Sometimes they're just working against us, and they're working against patients doing the same thing." [11:55]
• Dr. Drew (global context): "In the third world...when women are enticed to use these products...unfortunately, [they] are laced with heavy metals. This is epidemic—from Namibia all the way to Sierra Leone..." [12:10]
• Dr. Zirwas (rapid fire): "They can re-listen as many times as they want—that's part of the idea here." [36:14]

Timestamps by Segment

| Segment Topic | Speaker(s) | Timestamp | |--------------------------------------------------------------------|----------------------|-------------| | Welcome and panel introductions | Zirwas | 00:10 | | Pediatric eczema & emollients (CASCADE Trial) | Ferris (+panel) | 01:22–06:28 | | Sunscreen regulations & new agents | Patton, Drew, panel | 08:09–13:47 | | Lightning round: immune, alopecia, moisturizers, JAKs, IL-13 drugs | Zirwas, panel | 13:47–21:59 | | Resell device for vitiligo | Ferris, Patton | 22:05–26:18 | | At-home triamcinolone for acne | Patton, Ferris | 26:20–28:39 | | More "micro-pearls" from recent literature | Zirwas, panel | 28:39–36:00 | | Closing banter, wrap-up | All | 36:00–36:43 |

Final Tone & Takeaways

The lightning round format keeps the energy high, with each dermatologist offering succinct, practical interpretations and some good-natured critiques. The hosts embody a mix of excitement, skepticism, and a drive to clarify for colleagues what’s truly actionable in the flood of dermatology research. For listeners, this episode offers easily digestible updates, memorable soundbites, and a few laughs—living up to the show’s promise of “cutting edge derm meets hit-or-miss comedy.”

For further exploration:

• Topics mentioned have associated references in high-impact journals (JAMA Dermatology, JAD, etc.)
• Devices or drugs named (RECELL, new sunscreens, tralokinumab) can be searched for clinical trial details or local providers
• For clinical implementation questions (metformin in HS, ceramide creams in atopy), refer to institutional protocols or reach out to the co-hosts via their affiliated academic centers

Missed an episode? All key figures and tables are available on the video version at Scholars in Medicine.