Podcast Summary: "From Blood Vessels to Mighty Mites: What’s Hot (and maybe not) in Dermatology Right Now"

Podcast: Derms on Drugs
Hosts: Dr. Matt Zirwas, Dr. Laura Ferris, Dr. Tim Patton
Episode Date: November 14, 2025

Overview

This lively "six-pack" episode of Derms on Drugs features dermatologists Drs. Matt Zirwas, Laura Ferris, and Tim Patton as they each bring recent hot topics, studies, and quirky cases from the dermatology literature to the table. Themes range from prognostic criteria for small vessel vasculitis, new takes on wound care and melanoma management, to the dermatologic implications of popular medications and the surprising role of mites in "Jackne." The episode is loaded with clinical pearls, practical debates, and plenty of playful banter.

Key Discussion Points

1. Identifying Systemic Disease in Small Vessel Vasculitis

[00:54 - 12:21]

• Presenter: Laura Ferris
• Study: Margin et al., Brigham & Pennsylvania - 430 cases of small vessel vasculitis.
• Goal: Identify risk factors for systemic involvement in patients with cutaneous small vessel vasculitis.
• Criteria for Systemic Involvement: Chart diagnosis of systemic vasculitis, underlying connective tissue disease, or end organ dysfunction.
• Findings: (Multivariable Odds Ratios)
  • Nausea/vomiting: 3.92
  • Ulcerating/necrotic skin lesions: 3.26
  • Abdominal pain/cramping: 2.7
  • Fatigue/malaise/lethargy: 2.6
  • Significant hematuria on UA: 2.4
  • Protective factor: Recent antibiotic use (suggests more likely drug reaction/cutaneous only).
• Notable Quotes:
  • “I personally get a UA in everybody who comes in with cutaneous vasculitis, but now I don’t have to worry about trace hematuria as much.” – Laura Ferris, [05:58]
• Clinical Takeaway:
  • Systemic involvement is rare, but presenting symptoms like nausea and ulcerating lesions warrant a deeper work-up.

2. Dermatologic Side Effects of GLP-1 Receptor Agonists

[12:28 - 17:44]

• Presenter: Tim Patton
• Study: Burke et al., "Dermatologic Implications of GLP-1 Receptor Agonists"
• Highlights:
  • 6% of FDA-reported side effects are dermatologic.
  • Cosmetic concerns: “Ozempic face” (hollowing, sagging) and newly coined “Ozempic butt.”
  • Injection site reactions, hives/hypersensitivity, rare vasculitis, BP, psoriasis-form reactions.
  • Newer oral agents (semaglutide) linked to dysesthesia.
  • Mixed evidence about hair loss: Some studies say yes (TE), others no; some even report improvement in AGA.
• Memorable Quote:
  • “Halloween of the cheek, sunken eyes, sagging jowl. Seems to me that most cosmetic derms could manage these pretty easily with their various procedures and torture devices.” – Tim Patton, [13:05]
• Clinical Takeaway:
  • Expect to see more dermatologic effects as use skyrockets; most are manageable, but awareness is vital.

3. Optimal Dosing of Intralesional Triamcinolone for Alopecia Areata

[17:44 - 20:28]

• Presenter: Matt Zirwas
• Study: Prospective comparative study of triamcinolone concentration
• Findings: 2.5 mg/mL is the lowest effective dose; going down to 1.25 mg/mL is less effective.
• Banter: Comedic take on “girl math” for dilution calculations and a call for residency applicants to do math live.
• Clinical Takeaway:
  • Stick to 2.5 mg/mL for efficacy and to minimize side effects.

4. Wound Care: Hydrocolloid Dressings vs. Petroleum Ointment Post-Surgery

[20:28 - 25:23]

• Presenter: Matt Zirwas
• Study: Comparison after standard excision
• Results:
  • Short-term, hydrocolloid dressings speed healing and are more convenient/comfortable.
  • Long-term, no difference in scar appearance.
  • Slightly higher pain, bleeding, and dehiscence rates with hydrocolloids (not statistically significant).
  • Hydrocolloids are cheap, waterproof, and convenient, especially for ED&C or patients who need simple wound care.
• Memorable Quote:
  • “You can swim with it... especially like on the leg where I know all the water’s going to run down and get them infected, I really like having it for those.” – Laura Ferris, [25:09]
• Clinical Takeaway:
  • Hydrocolloid dressings are a patient-centered option, with minimal differences in outcomes for most post-surgical wounds.

5. Gene Expression Profiling (Merlin) to Predict Sentinel Node Status in Melanoma

[25:42 - 32:53]

• Presenter: Laura Ferris
• Study: Merlin 001, large prospective study (1,761 patients)
• Findings:
  • Merlin test had a negative predictive value of 93%; low-risk result just above threshold for skipping sentinel node biopsy (7.1% positive rate).
  • Only T1As had node positivity below 5%; T1Bs were 5.2%.
  • Editorial: GEP tests still cannot be used to definitively skip sentinel node biopsies under guidelines.
• Quotes:
  • “It did not however show that it could really pull out a nice low risk group that could safely forego sentinel node biopsy.” – Laura Ferris, [29:46]
• Clinical Takeaway:
  • GEP like Merlin adds info, but doesn’t eliminate need for sentinel node biopsy in most cases.

6. The Era of Cancer Blood Tests — Circulating Tumor DNA & "Cancer Guard"

[31:18 - 36:20]

• Presenter: Matt Zirwas/Group Discussion
• Highlights:
  • Circulating tumor DNA tests are now commercially available. Use is still unsettled with no solid guidelines.
  • Discussion of “Cancer Guard” — broad multi-cancer blood tests direct to consumer (self-pay, not insurance-covered).
  • Caution about downstream testing, patient anxiety, and false positives.
• Clinical Takeaway:
  • Technology is progressing, but utility in dermatology is unclear and use should be selective.

7. Oral Povorcitinib for Extensive Vitiligo: Phase 2 Data

[36:31 - 43:18]

• Presenter: Tim Patton
• Study: Amit Panja et al., Phase 2, JAD
• Results:
  • Modest improvement in total/body/face VASI scores over 52 weeks, especially at highest dose.
  • Only ~30% achieved F VASI 90 (90% face repigmentation) after a year at high dose.
  • No significant improvements in quality of life metrics.
  • Topical JAK inhibitors might have better risk-benefit than systemic for vitiligo.
• Quotes:
  • “Vitiligo is hard to treat and nothing really jumped out like on the safety data.” – Tim Patton, [40:19]
• Clinical Takeaway:
  • Oral JAKs are a possible, slow, and partial solution; best outcomes may come from combination therapy.

8. Topical Timolol for Spider Angiomas in Children

[44:12 - 45:18]

• Presenter: Matt Zirwas
• Study: Case series, 6 pediatric cases
• Results:
  • Two resolved, two improved, two failed; treatment cheap and safe, may be worth a try for cosmetic concern.
• Memorable Moment:
  • “A solution looking for a problem.” – Laura Ferris, [45:14]

9. Demodicosis and "Jackne" in IBD Patients on Rinvoq (Upadacitinib)

[45:26 - 51:14]

• Presenter: Matt Zirwas
• Study: Case series, IBD patients on various therapies
• Findings:
  • High rate of demodicosis in patients who developed acneiform eruptions on upadacitinib (90%).
  • Demodicosis vastly more common on JAK inhibitors than on biologics/conventional therapy.
  • Group muses: “Maybe that’s what Jackne is — it’s just Demodex.” – Laura Ferris, [46:34]
  • Therapeutic pearl: Oral ivermectin + metronidazole for papulopustular rosacea.
• Memorable Moment:
  • Banter about Demodex commercials with mites on TV and new approaches for extracting/examining Demodex.

Notable Quotes & Memorable Moments

• “I didn't even know there were [GLP-1] side effects besides hair loss. That's it? You lose too much weight and your hair falls out?” – Matt Zirwas, [13:01]
• “I would have to retire. I don't. I couldn't calculate that.” – Laura Ferris, [20:17] (joking about dose calculations)
• “Far as I’m concerned, hydrocolloids are a solution looking for a problem.” – Laura Ferris, [45:14]
• “Halloween of the cheek…Most cosmetic derms could manage these pretty easily with their various torture devices.” – Tim Patton, [13:05]
• “Maybe that’s what Jackne is. It’s just Demodex.” – Laura Ferris, [46:34]
• “Can we inject it and it'll make wrinkles go away?” – Matt Zirwas, [50:29] (regarding mite-paralyzing eyedrops)

Timestamps of Key Segments

• Small vessel vasculitis: [00:54 – 12:21]
• GLP-1 receptor agonist side effects: [12:28 – 17:44]
• Intralesional triamcinolone in AA: [17:44 – 20:28]
• Hydrocolloid dressing v. petroleum: [20:28 – 25:23]
• Melanoma gene profiling – Merlin: [25:42 – 32:53]
• CTDNA/Cancer Blood Tests: [31:18 – 36:20]
• Oral Povorcitinib in Vitiligo: [36:31 – 43:18]
• Timolol for Spider Angiomas: [44:12 – 45:18]
• Demodicosis/"Jackne": [45:26 – 51:14]

Tone & Format

The episode maintains an energetic, humorous, and collegial tone throughout, blending deep dives into literature with practical bedside wisdom and the hosts’ trademark banter. The dermatology is evidence-based but approachable, with clinical pearls and light-hearted asides breaking up the science. The hosts are candid about gaps in knowledge, patient communication, and even their own wound care practices.

Takeaways For Practitioners

• Vasculitis: Know concerning features for systemic involvement — don’t over-investigate every case.
• GLP-1 drugs: Side effects will be more common; recognize skin findings, and don't be surprised by new lingo (“Ozempic butt”).
• Alopecia: Use 2.5 mg/mL triamcinolone for intralesional therapy.
• Wound care: Hydrocolloid dressings can be considered for convenience; outcomes are similar to petroleum ointments.
• Melanoma: GEPs like Merlin are impressive but won’t replace sentinel node biopsy for now.
• Big data on cancer: Use cancer blood tests judiciously, and prepare for rise in patient-driven requests.
• Vitiligo: JAKs may help but aren’t panaceas; combination therapy and patient prep are key.
• Demodex and JAK inhibitors: Always consider demodicosis in patients with “JAKne”—it’s treatable!

End of summary.