2nd Annual San Diego Dermatology Symposium®
A Live Virtual Experience
June 11-13, 2021
A Live Virtual Experience
June 11-13, 2021
DAY 1 - DAILY SUMMARY
September 11, 2020
September 11, 2020
Acne and Rosacea: San Diego Dermatology Symposium® 2020 Highlights
Neal Bhatia, M.D.
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Dr. Neal Bhatia, MD, gave an excellent overview of recent updates in pathogenesis and treatment options in acne and rosacea. An evolving understanding of inflammatory mechanisms involved in the skin of acne mechanisms includes factors such as large numbers of CD4 T cells, early follicular expression of IL-1, a large macrophage presence in early acne lesions, and aberrant integrin expression in the epidermis around uninvolved hair follicles and inflamed lesions. Short chain fatty acids produced by Cutibacterium acnes inhibits keratinocyte histone deacetylases and leads to increased cytokine production and inflammation. Tetracycline antibiotic treatments may target cathelicidins, which are directly involved in acne pathogenesis as well.
There were many highlights of Dr. Bhatia’s talk in regard to topical and oral treatments. A few included discussions of trifarotene, a topical retinoid available which has a 20-fold selectivity for the RAR-y receptor over RAR-a and RAR-b. This may offer better improvement in acne than tretinoin and adapalene, and had high satisfaction rates in phase 3 trials. Topical minocycline foam had higher preferential concentrations in the epidermis and dermis vs plasma in comparison to oral minocycline. Sarecycline is a new tetracycline derivative antibiotic approved October 2018 for the treatment of moderate to severe acne with high activity against C. Acnes, and is comparable to minocycline and doxycycline. |
Clinical Pearls in the Management of Patients with Atypical Nevi and Melanoma: San Diego Dermatology Symposium® 2020 Highlights
Steven Wang, MD
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Dr. Steven Wang, MD, gave an informative review of the challenges in management of patients with atypical nevi and melanoma. Many melanomas do not fit the typical ABCDE criteria. 5 major pitfalls in diagnosis include featureless/hypomelanotic/amelanotic lesions, small size, collision lesions, “black swan” lesions (exceptions to the standard rules), and a “fuzzy” gold standard of histology (lesions may be challenging to diagnose on pathology as well as clinically).
Tracking change via vigilant follow-up is an important method to detect melanoma. Although it is widely accepted that earlier detection means better prognosis, modest delays of up to 6 months have not been shown to effect ultimate outcomes with superficial spreading melanoma and lentigo maligna melanoma. The exception is nodular melanoma, which should always be biopsied immediately if suspected. Additionally, the “ugly duckling sign” is a useful clinical and/or dermoscopic tool in identifying potentially atypical melanocytic lesions and may be defined by hyper- or hypopigmented nevi or solitary nevi. Dermoscopy has been shown to increase diagnostic accuracy by 25% in the hands of an experienced provider, and a total body skin exam with a dermatoscope only takes on average 2 minutes longer than without. Other clinical pearls discussed were that providers should be aware of pink lesions, use vessel morphologies to aid in diagnosis of amelanotic and hypomelanotic lesions, avoid anchoring error, and should not be timid in challenging the pathologist on a histopathologic diagnosis. |
Which Systemic Therapy for Which Psoriasis Patient?: San Diego Dermatology Symposium® 2020 Highlights
Jashin Wu, M.D.
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There are 11 biologics, 4 oral therapies, and 2 types of phototherapy (UVA and UVB). Since UVA is hardly used in psoriasis nowadays, that will not be included in the algorithms.
Dr. Wu’s treatment algorithm for psoriasis + active COVID-19 infection Discontinue any biologic and systemic immunosuppressive agents until the patient recovers from COVID-19
Dr. Wu’s treatment algorithm for psoriasis + high risk for COVID-19 infection
Dr. Wu’s treatment algorithm for psoriasis + PsA
Dr. Wu’s treatment algorithm for pediatric psoriasis
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