Anuj Budhiraja
Ajay Dulai
Gili Amid
Aye Taba
Gabriela Beraja
Thursday, August 21, 2025 | DAY ONE
The Gut–Skin Axis in Inflammatory Dermatoses: Clinical Applications of Microbiome Science | Speaker(s): Sonal Choudhary, MD | Thursday, 08/21/25 | 2:00 PM - 2:30 PM MST | Summary by: Gili Amid
The gut microbiome, composed of bacteria, viruses, and fungi, plays a central role in regulating digestion, immune responses, and systemic inflammation. Reduced microbial diversity can lead to mucosal barrier degradation, overgrowth of pathogenic bacteria, and increased pro-inflammatory cytokines, which contribute to various inflammatory and immune-mediated diseases. Factors such as antibiotic use, stress, and alcohol further disrupt gut balance and exacerbate disease severity. In dermatology, the gut-skin axis has gained increasing attention, with gut-derived tryptophan metabolites implicated in inducing itch in atopic dermatitis. Probiotics, prebiotics, and synbiotics offer promising therapeutic potential by restoring gut balance and modulating immune function, though their effects are strain-specific and require careful selection. In acne, combining probiotics with minocycline demonstrates greater efficacy, including reduced sebum production, compared with antibiotic therapy alone, while sarecycline preserves gut diversity more effectively than doxycycline or minocycline. Omega-3 fatty acids produce anti-inflammatory mediators, whereas omega-6 fatty acids promote pro-inflammatory pathways; studies show that acne patients are often omega-3 deficient, and supplementation significantly improves multiple acne subtypes. Dietary interventions, particularly adherence to a Mediterranean diet, enhance beneficial gut flora, decrease systemic inflammation, and improve disease outcomes in psoriasis and hidradenitis suppurativa (HS). For HS specifically, a yeast-free diet, weight reduction, and high-intensity physical activity may further reduce symptoms. Additionally, GLP-1 receptor agonists support short-chain fatty acid-producing bacteria, strengthen gut barrier integrity, and decrease systemic inflammation, making them a promising adjunct in metabolic and inflammatory skin conditions.
Integrative Aesthetic Strategies for the Changing Face of Weight Loss: Ozempic and Beyond | Speaker(s): Martha Viera, MD | Thursday, 08/21/25 | 2:30 PM -3:00 PM MST | Summary by: Aye Taba
Dr. Martha Viera addressed the emerging aesthetic challenge of “Ozempic Face,” characterized by rapid facial volume loss in patients using GLP-1 agonists for weight reduction. She highlighted that these patients often experience a mismatch between their slimmer bodies and prematurely aged facial appearance, which can deeply affect self-image and emotional well-being. Management requires more than fillers alone; Dr. Viera emphasized stepwise, multimodal protocols that combine biostimulatory therapies, ultrasound-based skin tightening, and supportive skincare to restore volume and improve hydration.
She advised sequencing treatments carefully, beginning with energy-based devices to stimulate collagen and elastin before adding fillers for structural support. She shared real patient cases demonstrating natural improvements with ultrasound, biostimulators, and skincare, emphasizing restoration rather than overcorrection. She also underscored the importance of emotional intelligence in patient interactions, noting that GLP-1 users often rely on physician guidance rather than arriving with preset aesthetic demands. Red light therapy, nutrigenomic support, and RF microneedling were discussed as adjuncts to reduce inflammation and enhance outcomes. Dr. Viera also recommended strength training to counteract muscle atrophy associated with weight loss and to complement aesthetic results. Finally, she called for further research on collagen biology in this patient population to refine regenerative protocols and improve long-term outcomes.
Raging Hormones, Radiant Skin: The Mic Falls Here! Speaker(s): Sahar Swidan, PHARM.D., ABAAHP, FAARFM, Thursday, 08/21/25 | 3:00 PM - 3:30 PM MST | Summary by: Ajay Dulai
Sahar Swidan provided us with a lecture regarding the effects of hormones on skin health, particularly as we age. For example, postmenopausal females have reductions in estrogen which prevents stimulation of collagen, elastin, and hyaluronic acid to maintain healthy skin. Similarly in men, testosterone has been shown to regulate oil production in the sebaceous glands. T3 and T4 regulate keratinocyte function and wound healing, explaining why hypothyroid patients can have dry and flakey skin. Cortisol has shown to decrease the expression of tight junction genes, potentially leading to an impaired skin barrier
Hormone replacement therapy (HRT) can help to restore collagen, firmness, and hydration, but must be used with caution to remain within physiological limits. Testosterone tends to be overdosed in men and women which may induce acne. Dose form should also be carefully considered; estrogen is preferred to dose through a transdermal route as it demonstrates similar efficacy without the systemic effects of oral therapy. It is important to think of HRT as an adjunct to traditional therapy, but HRT in the right patient can be effective in improving skin health.
Interactive Case Discussions | Speaker(s): Raja Sivamani, MD MS AP | Thusday, 08/21/25 | 4:00 PM - 4:30 PM MST | Summary by: Ajay Dulai
Dr. Raja Sivamani gave us a case presentation to help bridge the gap between education and practicality. He presented a severe psoriatic patient with a BMI of 29.2. Research has demonstrated that weight loss can improve psoriasis severity, but Dr. Sivamani urges clinicians to also consider muscle mass, fatty liver, and metabolic health when assessing health. He recommends entering the conversation of weight by initially talking about diet and nutrition such as, “how do you think diet and weight is affecting you?”
This patient, likely due to his carnivore diet and lack of fiber, had a lack of several commensal bacteria which produce short-chain fatty acids in our gut. Metabolic health was assessed with the omega-3 index, comprehensive lipid panel, Apolipoprotein B, liver function tests, anti-gliadin antibodies and HOMA-IR. This patient demonstrated a low omega-3 index, and an elevated LDL, apolipoprotein B, and HOMA-IR.
This patient was prescribed 2000 mg DHA to address the omega-3 deficiency. Reduction in carbohydrate intake, increase in dietary protein, and intermittent fasting was discussed to address metabolic health. Deucravacitinib was prescribed to address skin manifestations. After starting this protocol for four months, the patient’s BMI reduced to 25.4, HOMA-IR reduced, and psoriasis cleared. Ultimately, this patient felt empowered with his ability to change the course of his health.
From Plate to Practice: Protein-Rich Recipes and Strategies for Patients Undergoing Weight Loss | Speaker(s): Chef Kimber Dean and Raja Sivamani, MD MS AP | Thursday, 08/21/25 | 4:30 PM - 5:00 PM MST | Summary by: Gabriela Beraja
This session highlights the unique nutritional needs of patients on GLP-1 receptor agonists for weight management. These medications effectively reduce appetite and support fat loss, but they may also result in 20–50% lean body mass loss, including muscle and connective tissue. Preserving muscle is essential, and requires a combination of resistance training and adequate protein intake.
Dr. Sivamani speaks on how much protein is enough. Standard protein recommendations are 0.8 g/kg/day, but patients engaged in resistance exercise benefit from 1.2–1.6 g/kg/day. Both animal-based proteins (meat, poultry, eggs, dairy, fish) and plant-based proteins (soy, quinoa, tempeh, hemp, chia) can provide complete amino acid profiles. Notably, Chef Kimber emphasized obtaining daily protein from whole foods, and Dr. Sivamani highlights the importance of considering saturated fats and carbohydrate content when selecting protein sources.
Chef Kimber provides practical meal examples, such as a roasted sweet potato recipe, giving clinicians concrete options to recommend to patients rather than simply advising them to “eat healthy.” Ultimately, protein-centered meals combined with strength training promote muscle preservation and enhance long-term outcomes for GLP-1–treated patients.
Psoriasis and Obesity: Going Pound for Pound on Comprehensive, Patient-Centered Management Supported by Independent Educational Grant from Lilly | Speaker(s): Dr. Jaime Almandoz, Dr. Daniel Butler, and Dr. Benjamin Ungar | Thursday, 08/21/25 | 5:30 PM - 6:30 PM MST | Summary by: Anuj Budhiraja
Drs. Benjamin Ungar, Jaime Almadoz, and Daniel Butler convened a panel to discuss clinical recommendations for the management of obesity in patients with psoriasis. The panel emphasized that approximately 37% of patients with psoriatic arthritis are affected by obesity, and growing evidence highlights the bidirectional exacerbating effects of psoriasis and metabolic disease, mediated by pro-inflammatory signaling pathways and adipokines such as leptin, which also contribute to heightened cardiovascular morbidity. This relationship holds particular significance in clinical practice, as obesity has been shown to diminish systemic therapeutic response rates in psoriasis management. To underscore clinical relevance a patient was included on the panel to illustrate the importance of shared decision-making and patient perspective of obesity care, complemented by general expert recommendations. Based on the AAD–NPF guidelines, the panel advised that comprehensive cardiometabolic risk assessment should be performed annually in all patients with psoriasis, including evaluations of BMI, waist circumference, blood pressure, lipid profile, and lifestyle factors such as diet, exercise, and tobacco use. More aggressive screening strategies were recommended for patients with extensive disease, particularly those eligible for systemic therapy or phototherapy or with body surface area involvement exceeding 10%. Regular screening was emphasized as critical for the early detection of obesity, thereby enabling timely interventions that reduce long-term complications. The panel further advised that discussions surrounding obesity management should be approached with sensitivity by first obtaining patient permission to discuss weight, exploring current health behaviors, and eliciting patient-defined goals to guide individualized care. Goals were underscored as central to intervention selection, with lifestyle modification forming the foundation of management, while escalation to pharmacotherapy was deemed appropriate for patients aiming for 5–10% body weight reduction, and procedural interventions for those targeting 10–20%. The experts highlighted the importance of counseling patients early on regarding the availability of pharmacologic options, particularly for those with a history of difficulty initiating or sustaining weight loss, while providing clear discussions of risks and benefits. They noted that the therapeutic landscape includes multiple FDA-approved medications with diverse mechanisms of action beyond GLP-1 receptor agonists, as well as off-label agents, and that selection should be tailored to comorbidities, patient preferences, and side-effect profiles. Ultimately, prescribing decisions remain the responsibility of the individual provider, and the panel recommended a collaborative multidisciplinary approach involving primary care physicians, nutritionists, and other practitioners to optimize patient outcomes.
Friday, August 22, 2025 | DAY TWO
Topical Steroid Withdrawal - Myth or Fact? | Speaker(s): Vivian Shi, MD FAAD | Friday, 08/22/25 | 9:00 AM - 9:30 AM MST | Summary by: Aye Taba
Dr. Vivian Shi explored the clinical and emotional complexity of topical steroid withdrawal (TSW), a condition increasingly recognized by patients but still under debate in the medical literature. She emphasized appropriate steroid use, including potency selection by body site, fingertip unit dosing, and tapering strategies to reduce misuse and side effects. TSW was presented as a distinct entity from tachyphylaxis and underlying dermatoses, with hallmark features like burning, erythema, “red sleeves,” and elephant wrinkles. Patients using medium- to high-potency steroids on the face or folds for extended periods appear most at risk. Fear of TSW is a major driver of nonadherence in atopic dermatitis, especially among adults who may experience symptoms for years. While diagnostic criteria are still evolving, TSW should be considered only after ruling out other conditions. Emerging research suggests mitochondrial dysfunction and excess NAD+ may play a role, with early reports of improvement using metformin and berberine. Management focuses on gradual tapering, nonsteroidal alternatives, biologics, and supportive care including psychological support. Dr. Shi urged clinicians not to let fear of TSW prevent appropriate prescribing, calling for individualized action plans and stronger partnerships with patient communities. Her message was clear: stewardship and empathy must guide treatment decisions.
Pigmentary Disorders Update | Speaker(s): Seemal Desai, MD FAAD | Friday, 08/22/25 | 9:30 AM - 10:00 AM MST | Summary by: Anuj Budhiraja & Aye Taba
Dr. Seemal Desai delivered a comprehensive lecture on advances in therapeutic approaches for vitiligo, highlighting both established strategies and emerging treatments. He emphasized that vitiligo is not a rare disease, with prevalence estimates as high as 1 in 50 individuals, over 50% pre-adulthood onset, and significant psychosocial burden, especially among patients with skin of color, in whom cultural and familial stigmatization often compounds the impact of disease. At the outset of management, Dr. Desai underscored the importance of performing a comprehensive full-body skin examination to identify subclinical lesions, along with discussing patient-specific goals such as desire for focal or complete repigmentation. Key clinical scenarios in which escalation to advanced therapies should be considered include refractory disease, rapidly progressive disease exceeding 1% BSA over 6–8 weeks, trichrome or confetti vitiligo, koebnerization, and extensive involvement of the digits, all of which are suggestive of unstable disease. Stabilization strategies were described within a polytherapeutic framework, including oral mini-pulse corticosteroid therapy (dexamethasone 2 mg on two consecutive days per week), Polypodium leucotomos 250 mg three times daily combined with narrowband UVB phototherapy twice weekly, systemic antioxidants such as alpha lipoic acid, vitamin E, and vitamin C, and topical JAK inhibitors such as ruxolitinib 1.5% cream applied twice daily, which demonstrated significant reductions compared to vehicle in non-segmental vitiligo. The therapeutic landscape is rapidly expanding with novel agents under investigation, including bromodomain and extraterminal protein inhibitors, oral JAK inhibitors such as upadacitinib 15 mg daily, povorcitinib 45–75 mg daily, and ritlecitinib with clinically significant improvements in facial VASI, immunologic therapies targeting IL-15 and CXCL10, and procedural interventions such as outpatient autologous melanocyte stem cell transplantation using a dermablade shave technique, which has demonstrated durable repigmentation up to 52 weeks. Importantly, Dr. Desai dispelled the misconception that JAK inhibitors must be paired with phototherapy, clarifying that while synergistic, they are effective as monotherapy. Dr. Desai also extended his discussion to melasma, noting its comparable psychosocial burden and advances in understanding its vascular and angiogenic pathogenesis. He recommended evidence-based triple therapy regimen for acute flares (hydroquinone, retinoid, and low-potency topical corticosteroid for 3 months) supported by RCT data, while emphasizing that triple therapy should not be used for maintenance and instead incorporated into rotational regimens. Adjunctive and maintenance strategies include hydroquinone which is foundational and adjunctive azelaic acid 20% cream applied twice daily, oral antioxidants such as green tea extracts, procyanidin, zinc, and oral polypodium leucotomos 240 mg three times daily, and tranexamic acid 250–500 mg daily in topical, oral, or intradermal formulations for refractory melasma, with appropriate counseling on thromboembolic risk. He also highlighted emerging adjuncts including metformin and oral antihistamines such as ketotifen and famotidine. Dr. Desai concluded that the future of vitiligo and melasma management is highly promising, with increasingly integrative approaches targeting multiple mechanisms of disease.
Interactive Case Discussions | Speaker(s): Raja Sivamani, MD MS AP | Friday, 08/22/25 | 11:10 AM - 12:00 PM MST | Summary by: Gabriela Beraja
Dr. Sivamani’s session presented two clinical cases illustrating integrative care for psoriasis and atopic dermatitis (AD). The first case was a 45-year-old male with extensive plaque psoriasis and psoriatic arthritis who had failed multiple conventional therapies. A multimodal regimen combining systemic and topical treatments, phototherapy, turmeric supplementation, and lifestyle changes proved effective. Additional evidence supported complementary options such as Neem (500–1000 mg; ¼ teaspoon ≈ 500 mg) for cutaneous improvement and curcumin (200–1000 mg) for joint pain. The LITE randomized clinical trial (JAMA 2024) was highlighted, showing that home phototherapy is as effective as office treatment, with superior adherence and reduced costs when covered by insurance.
The second case involved a 50-year-old female with longstanding AD, poor tolerance of topical therapies, and concerns about dietary triggers. Functional testing assessed gut permeability, food sensitivities, and omega-3 status. Studies showed that short-course high-dose L-glutamine (30 g/day for 2 weeks) may improve gut permeability, and specific probiotic strains, Lactobacillus salivarius LS01 and Bifidobacterium breve BR03 in adults, and Bifidobacterium lactis CECT 8145, B. longum CECT 7347, and Lactobacillus casei CECT 9104 in children, were beneficial for AD. Omega-3 supplementation produced mixed results, with some improvements in adults but less clear benefit in infants. Dietary sources include salmon, tuna, cod liver, and algae (vegan DHA). Phototherapy was reviewed as an effective adjunct in both children and adults, with home use supporting strong adherence and clearance rates.
Overall, the lecture emphasized tailoring treatment to the unique pathophysiology of psoriasis and AD by integrating conventional and complementary approaches.
An Integrative Approach to Eczema Panel | Speaker(s): Sarina Elmariah, MD PhD MPH, Elizabeth Swanson, MD; Michael Traub, ND | Friday, 08/22/25 | 1:30 PM - 2:30 PM MST | Summary by: Gili Amid
Dr. Lio, Dr. Elmariah, Dr. Swanson, and Dr. Traub hosted a panel titled “An Integrative Approach to Eczema” that explored the heterogeneity of atopic dermatitis and the interplay between skin barrier dysfunction, microbiome imbalance, and immune dysregulation involving IL-4, IL-13, and IL-31. Management extends beyond the skin, addressing family impact, stress, and lifestyle factors. Early recognition is critical as itch often precedes visible lesions, and dietary triggers require distinguishing true allergies from intolerances or contact dermatitis. Emerging strategies include hempseed oil for barrier repair, vitamin D supplementation (monitor with 24-hour urinary calcium), hypochlorous acid spray for microbiome restoration, wet wrap therapy, and spa-based interventions. Colostrum may support patients with recurrent S. aureus colonization, while acupuncture and acupressure show benefit in refractory itch. The panel also highlighted the importance of early-life microbial exposures, with studies showing that mode of delivery, breastfeeding, and microbiome diversity influence eczema risk, providing opportunities to guide expecting parents on optimizing early skin and gut health. Additionally, access to green spaces and stress reduction strategies may help lower flare frequency. A comprehensive, personalized approach that integrates immune, environmental, and psychosocial factors remains essential for improving patient outcomes.
Whealing and Dealing with Chronic Spontaneous Urticaria | Speaker(s): Sarina Elmariah, MD | Friday, 08/22/25 | 2:30 PM - 3:00 PM MST | Summary by: Anuj Budhiraja
Dr. Elmariah began with a discussion of epidemiology with chronic spontaneous urticaria (CSU) representing approximately 80% of all chronic urticaria cases and disease prevalence peaking in the third to fourth decades of life. Dr. Elmariah emphasized the prolonged patient journey, noting that, in her practice, 75% of her CSU patients had already consulted allergists and over half had seen multiple dermatologists, reflecting delayed control and significant psychosocial burden, including a threefold increased risk of suicidal ideation. Pathogenetically, CSU is driven by both immunologic and non-immunologic mast cell degranulation, which perpetuates adaptive immune activation and chronic inflammatory signaling. Diagnosis requires confirmation of urticarial lesions persisting beyond six weeks and resolving within 24 hours, with subclassification into type 1 (IgE-mediated autoallergic) and type 2 (IgG/IgM-mediated autoimmune) endotypes, the latter associated with poorer response to antihistamines and anti-IgE therapies. Baseline laboratory testing should include CBC with differential, CRP, ESR, total IgE, anti-TPO antibody, TSH, and basophil assays to distinguish autoimmune subtypes, with advanced evaluations reserved for cases suggestive of systemic autoimmune, infectious, or syndromic disease; she suggested biopsy is often unnecessary unless alternate urticarial dermatoses are suspected. Treatment follows a stepwise algorithm beginning with standard-dose second-generation antihistamines, titrated up to 4× the standard dose at weekly intervals if uncontrolled, with validated tools such as the Urticaria Control Test (UCT) guiding escalation. For refractory disease, biologic therapy with omalizumab—an anti-IgE monoclonal antibody FDA-approved in 2014—achieves improvement in 52–58% of patients with up to 40% achieving complete remission, while real-world studies suggest responder rates as high as 80%. Dupilumab, FDA-approved in April 2025, acts via IL-4Rα blockade to inhibit IL-4 and IL-13 signaling, with CUPID A and C trials demonstrating efficacy. Emerging therapies include remibrutinib, an oral twice-daily Bruton’s tyrosine kinase (BTK) inhibitor that suppresses mast cell and basophil degranulation, which is among the developing therapies showing promising efficacy in CSU.
What's the Big Deal: The Impact of Anti-Obesity Treatments on Psoriasis | Speaker(s): Jennifer Soung, MD | Friday, 08/22/25 | 3:00 PM - 3:30 PM MST | Summary by: Anuj Budhiraja
Dr. Soung began by emphasizing the high prevalence of obesity in patients with psoriasis and psoriatic arthritis, where it worsens systemic inflammation and reduces therapeutic response to systemic agents. Clinical evidence supports that weight loss interventions can meaningfully improve dermatologic outcomes such as, in one trial, a 10-week program incorporating a very low-calorie ketogenic diet (<500 kcal/day) followed by a Mediterranean-style hypocaloric regimen achieved an average 12% body weight reduction and PASI-75 responses in nearly two-thirds of participants. Pharmacologic therapies targeting metabolic pathways also appear promising. Liraglutide at 3.0 mg daily, a GLP-1 receptor agonist, has demonstrated PASI improvements in meta-analyses of psoriatic patients with diabetes through downregulation of IL-17, IL-23, and TNF-α signaling. Similarly, semaglutide at 2.4 mg weekly has yielded marked improvements, with case reports describing reductions in PASI from 33 to 3 and DLQI from 26 to 0 over a 10-month treatment period. Tirzepatide, a dual GIP/GLP-1 receptor agonist administered at 10 mg weekly, has achieved >20% mean weight loss in phase 3 obesity trials and is under investigation in psoriasis- and psoriatic arthritis–specific studies. These data suggest that clinicians should integrate structured weight-loss programs and, when indicated, incretin-based therapies into the therapeutic algorithm for patients with psoriasis and obesity, in parallel with conventional systemic and biologic agents. The accumulating evidence highlights the importance of addressing the metabolic–inflammatory axis as a therapeutic target in psoriatic disease. These findings underscore the bidirectional interplay between metabolic disease and psoriatic inflammation, suggesting that treatment of obesity may serve as a disease-modifying strategy in psoriatic patients; however, further investigation is needed to confirm durability of PASI and DLQI responses and to define the magnitude of benefit when combined with biologics, and additional investigation is warranted to clarify which psoriatic subpopulations derive the most substantial improvements. For practicing clinicians, this growing body of research implies that early recognition and management of obesity should be incorporated into comprehensive psoriasis care. The therapeutic algorithm should integrate lifestyle modification, structured dietary programs, and when appropriate, pharmacologic metabolic therapies alongside conventional systemic and biologic psoriasis treatments. Ultimately, targeting the metabolic–inflammatory axis may offer a novel paradigm for durable disease control in psoriatic disease.
Interactive Case Discussions | Speaker(s): Raja Sivamani, MD MS AP | Friday, 08/22/25 | 4:30 PM - 5:30 PM MST Summary by: Ajay Dulai
Dr. Sivamani completed a case discussion regarding hair health with practical pearls to apply to clinical practice. He stressed the importance of acknowledging and not dismissing the concerns of the patient’s hair and urged that the integrative approach to hair health must consider all factors which can push a patient into the telogen phase of a hair follicle: diet, medications, stress, hormones, and inflammation.
In the first case, Dr. Sivamani used an integrative approach to manage a patient’s hair loss. She was taking biotin with unsatisfactory results. He obtained a holistic set of labs including vitamin D, ferritin, TSH, fasting insulin, fasting glucose, HbA1c, and organic acid profile, and then stressed that it was important to pause biotin for one week prior to taking lab results. He found the subject to be pre-diabetic, a finding which no other clinician had thought to check. His integrative approach included iron supplementation, NeoGenesis Hair Thickening Serum, vitamin B complex, strength training, and walks after dinner. Using this protocol, he was able to help the patient achieve hair regrowth that she was satisfied with.
The second patient was a male with hair loss concerned about the potential side-effects of finasteride and dutasteride. Dr. Sivamani utilized oral minoxidil, Neogeneis Hair Serum, nutrafol Men, and topical pumpkin seed oil. Using this protocol, the patient was able to address stress, improve mitochondrial health, and increase anagen to telogen transition. Ultimately, the patient was satisfied with the results. Dr. Sivamani recommends using supplements, interventions, and medications which target several aspects of holistic health, as he demonstrated in these cases.
Saturday, August 23, 2025 | DAY THREE
What's New in Rosacea 2025 | Speaker(s): Neal Bhatia, MD | Saturday, 08/23/25 | 11:00 - 11:30 AM | Summary by: Gili Amid
Dr. Bhatia presented the latest updates on understanding and managing rosacea, highlighting new insights into its causes, symptoms, and treatment options. Rosacea is a complex condition influenced by neurovascular dysregulation, immune activation, genetics, and environmental triggers. Heat, alcohol, spicy foods, UV exposure, and stress can activate sensitive pathways, leading to flushing, burning, itching, and persistent redness. New research highlights the role of vasoactive peptides like substance P, VIP, and PACAP, as well as innate immune factors such as DAMPs and LL-37, which drive inflammation and vessel dilation. Rosacea can be challenging to diagnose, especially in darker skin types where erythema is less visible, making patient-reported symptoms like burning and sensitivity increasingly important. Ocular involvement should also be assessed since eye symptoms are often subtle but clinically significant.
Treatment strategies continue to evolve, focusing on personalized care. Topical therapies like metronidazole and azelaic acid remain first-line, with optimized formulations improving tolerability and outcomes. For more resistant cases, systemic therapies play a key role. The newly FDA-approved low-dose minocycline offers once-daily dosing with improved safety, while sarecycline provides effective lesion reduction with minimal GI side effects. Adjunctive approaches are also expanding, including carvedilol and gabapentin for persistent flushing, erenumab for neurovascular-driven erythema, and even botulinum toxin for refractory cases. Integrated skincare with antioxidant-rich botanical gels and natural agents like aloe vera and licorice further support skin barrier health, offering a more comprehensive approach to rosacea management.
Vitiligo: Integrative Approaches to Evaluation and Treatment | Speaker(s): Nada Elbuluk, MD MSc | Saturday, 08/23/25 | 11:30 AM - 12:00 PM MST | Summary by: Aye Taba
Dr. Nada Elbuluk highlighted the growing role of holistic and integrative approaches in vitiligo care, emphasizing the need to address both medical and lifestyle factors. Studies show that about one-third of patients use complementary and alternative therapies, often driven by frustration with limited efficacy, side effects, or costs of conventional treatments. Patients of SoC were more likely to try these therapies, reflecting cultural acceptance of traditional practices. However, fewer than half disclose this use to physicians, underscoring the importance of asking directly about supplements, diets, and alternative treatments.
Common patient strategies include camouflage, vitamin B12, vitamin D, zinc, and ginkgo biloba. Dr. Elbuluk reviewed evidence on antioxidants, vitamins (B12, D, C, E, folic acid), and botanicals such as ginkgo, Polypodium leucotomos, and turmeric. These agents may enhance phototherapy outcomes and reduce oxidative stress, with small trials supporting their benefit, though overall evidence remains limited and heterogeneous. Minerals like zinc, copper, and selenium show inconsistent effects, and diet-based interventions, such as gluten-free diets, lack robust data except in cases with comorbidities like celiac disease.
Emerging areas of interest include the gut microbiome, which shows distinct differences in vitiligo patients and may represent a future therapeutic target. Lifestyle measures such as reducing alcohol intake, avoiding high-fat diets, exercising regularly, and supporting mental health were emphasized as practical, evidence-informed strategies.
Dr. Elbuluk concluded by encouraging clinicians to adopt a holistic, personalized approach that integrates conventional therapies with safe, evidence-informed complementary options. She stressed the importance of open dialogue about supplements and lifestyle factors, combined treatment strategies, and ongoing research to better define the role of integrative care in vitiligo.
Qi, Circulation, and Skin Health: Movement as Medicine in TCM | Speaker(s): Joseph Alban, DAc | Saturday, 08/23/25 | 2:00 PM - 2:30 PM MST | Summary by: Anuj Budhiraja
Joseph Alban’s lecture on Chinese medicine, exercise, and skin health emphasized both traditional and modern perspectives on how movement influences dermatologic outcomes. In Chinese medicine, concepts such as Yang Qi, and the balance between yin and yang, play a central role; when these forces become dysregulated, they are believed to contribute to cutaneous manifestations. Exercise is considered one of the core therapies in Chinese medicine, offering a means to regulate these imbalances and improve skin health. From a biomedical perspective, the link between exercise and skin health is well established, particularly through AMPK activation and IL-15 myokine–mediated improvements, which support mitochondrial biogenesis and reduce signs of skin aging. Different exercise modalities can be mapped to addressing distinct yin-yang imbalances, aligning traditional philosophy with tailored movement therapies.
Supporting data from a 12-week intervention study demonstrated that high-intensity interval training (HIIT) led to the greatest improvement in VO₂ max, resistance training yielded the most significant gains in fat-free mass and leg strength, while cardiovascular training showed the least molecular impact. Tai chi was highlighted for its antioxidative benefits, including increases in superoxide dismutase activity, decreases in malondialdehyde levels, and enhancement of OGG1-related DNA repair capacity. A cross-sectional study further revealed that tai chi practice improved nitric oxide signaling in the skin and enhanced endothelium-dependent dilation, pointing to vascular and dermal benefits. Gua Sha, another modality in Chinese medicine, is believed to promote the flow of Qi and blood, clear heat and toxins, and provide cosmetic improvements; importantly, a pilot study showed that Gua Sha increased microcirculation by up to 400%, with the effect persisting for 25 minutes post-treatment. Together, these findings illustrate how traditional Chinese therapies and modern exercise science intersect, offering integrative strategies to support circulation, balance internal forces, and enhance skin health.
Cocoa in Skincare | Speaker(s): Zoe Diana Draelos, MD | Saturday, 08/23/25 | 2:30 PM - 3:00 PM MST | Summary by: Anuj Budhiraja
Dr. Zoe Draelos presented on the dermatologic applications of cocoa, highlighting its growing incorporation into U.S. skincare due to its polyphenol content. Cocoa beans yield powder and butter, both of which have clinical utility, though the primary bioactivity stems from flavanols such as epicatechin and catechin. These compounds act as topical antioxidants and may provide UV protection through suppression of IL-2 and NF-κB–mediated inflammatory signaling. For therapeutic activity, cocoa polyphenols must be stably formulated, present at sufficient concentration, penetrate the stratum corneum, and remain biologically active.
A controlled study investigated stratum corneum penetration of cocoa polyphenols following topical application of a 6% cocoa powder solution. Five healthy female volunteers received 2 cc of solution under occlusion, and sequential D-squame tape stripping at one and two hours allowed quantification by LC-MS. Results showed epicatechin penetration of 5–37 ng and catechin penetration of 4–18 ng, reaching approximately 10 stratum corneum layers, with both compounds stable in the skin. These findings confirm that cocoa polyphenols can form a biologically relevant epidermal reservoir.
Limitations include the complexity of cocoa powder, which contains thousands of compounds that may confound LC-MS quantitation, though consistent results demonstrated higher epicatechin than catechin levels. Beyond mechanistic work, clinical implications are notable: oral cocoa demonstrates photoprotective and anti-inflammatory effects, while topical cocoa butter provides occlusion but requires combination with cocoa powder to deliver antioxidant bioactivity.
Early clinical research in 25 women applying cocoa formulations twice daily for eight weeks to scars and stretch marks showed improvements in dryness, smoothness, radiance, and erythema, supported by dermaspectrophotometer measurements. Interim six-week results confirm moisturization and anti-inflammatory benefit, underscoring cocoa’s potential as an integrative dermatologic intervention.
From Bean to Beauty: The Cocoa Journey (Afternoon Break & Self-Care for the Practitioner) | Speaker(s): Adriana Cruz, MD | Saturday, 08/23/25 | 3:00 PM - 3:30 PM MST | Summary by: Gili Amid
Dr. Cruz took us behind the scenes of the chocolate making process, exploring how cacao transforms from raw beans into one of the most beloved indulgences in the world. The journey begins with fermentation, where yeasts and bacteria create chemical changes inside the bean, breaking down cell membranes and converting proteins into flavor forming amino acids. During this process, alkaloids like theobromine and caffeine are partially released into the shell, which helps reduce bitterness. Next comes drying, which lowers moisture from about 55 to 60 percent to just 6 to 8 percent, stabilizing flavor, reducing acidity, and preventing mold formation. Roasting then unlocks the signature chocolate aroma and taste through the Maillard reaction, where heat, amino acids, and sugars combine to create deep flavors and rich colors.
After roasting, the nibs are separated from the shell and ground into cacao liquor, a mixture of cocoa solids and cocoa butter used in many chocolate products. Tempering follows, a careful heating and cooling process that stabilizes fat crystals, giving chocolate its smooth glossy finish and preventing fat blooming. Dr. Cruz also explored the three worlds of chocolate: dark, milk, and white, each with distinct textures, flavors, and compositions based on different proportions of cocoa solids, cocoa butter, sugar, and milk. Beyond taste, she highlighted chocolate’s cultural history, nutritional properties, and the craftsmanship involved in every step from bean to bar, giving attendees a deeper appreciation for the science, artistry, and care behind creating high quality chocolate.
Interactive Case Discussions - Acne | Speaker(s): Raja Sivamani, MD MS AP | Saturday, 08/23/25 | 3:45 PM - 4:45 PM MST | Summary by: Gabriela Beraja
This interactive session, led by Dr. Sivamani, introduced a structured framework for evaluating acne that moves beyond conventional classification. Clinicians were encouraged to consider multiple domains: lesion dominance (comedonal vs. inflammatory), hormonal influence (estrogen vs. androgen dominance), metabolic status (insulin resistance vs. non–insulin resistance), systemic inflammation (omega-3 deficiency and gut dysbiosis), and stress patterns (flattened vs. normal cortisol slope). Diagnostic tools highlighted included the DUTCH test for hormone profiling, fasting insulin and glucose with HOMA-IR for metabolic assessment, Omega-3 Index testing, microbiome panels such as BiomeFx and GI-MAP, and four-point cortisol testing for stress.
Stress was emphasized as a key factor that can aggravate acne. Dr. Sivamani reviewed supplements with evidence-based benefits, including ashwagandha (250–600 mg daily), which improves sleep and stress resilience but may increase testosterone at high doses, and holy basil (~250 mg daily), which demonstrated reductions in stress, insomnia, and cortisol levels in clinical trials. Omega-3 supplementation (600–800 mg DHA with 300–400 mg EPA daily) was also shown to improve both systemic inflammation and acne severity within 12–16 weeks. Dr. Sivamani emphasized the importance of incorporating a probiotic into a patient’s care plan when prescribing antibiotics. He also recommended adding almonds to meals (~20 g), noting that recent evidence suggests they may help reduce hemoglobin A1c levels and acne.
Finally, Dr. Sivamani presented data on Nutrafol Skin, a nutraceutical targeting internal drivers of acne. In a placebo-controlled study, 44% of participants achieved clear or almost clear skin by 12 weeks compared to 13% on placebo. Lesion counts dropped by over 50% for both inflammatory and non-inflammatory acne, with additional improvements in pigmentation, scarring, skin tone, and overall appearance.
Overall, the session underscored the value of combining integrative and conventional approaches to create personalized treatment strategies for acne patients.
Sunday, August 24, 2025 | DAY FOUR
Tipping the Scales: Integrative Approaches to Psoriasis | Speaker(s): Steven Daveluy, MD, FAAD | Sunday, 08/24/25 | 9:00 AM - 9:30 AM MST | Summary by: Aye Taba
Dr. Steven Daveluy reviewed how integrative strategies can enhance psoriasis management by combining new pharmaceutical options with lifestyle and complementary approaches. He outlined advances in topical therapy, including fixed-dose steroid/retinoid combinations and agents targeting the aryl hydrocarbon receptor and PDE4, which offer once-daily dosing and sustained clearance after treatment breaks. Biologics remain highly effective, with IL-17 and IL-23 inhibitors achieving near-complete clearance for many patients; however, side effects such as oral candidiasis with IL-17 blockade prompted discussion of preventive strategies like xylitol lozenges to support the oral microbiome. Dr. Daveluy also introduced novel agents such as deucravacitinib (a TYK2 inhibitor) and IL-36 inhibitors for pustular psoriasis, which expand systemic treatment options.
Dietary factors were highlighted as an important part of integrative care. Gluten sensitivity testing may help identify subsets of patients who respond to a gluten-free diet, while the Mediterranean diet has been shown to improve metabolic health and enhance outcomes when paired with TNF inhibitors. Supplementation with omega-3 fatty acids provided additional benefit when combined with dietary adjustments. Stress management and mental health support also play a role, with studies showing that guided meditation during phototherapy sessions can improve treatment response.
Complementary therapies such as turmeric (curcumin), indigo naturalis, and aloe vera have demonstrated anti-inflammatory benefits in small studies, though practical issues like staining and product variability remain challenges. Acupuncture and probiotics show promise but require more rigorous evidence before routine use. Dr. Daveluy encouraged clinicians to consider accessible tools such as dietary handouts and patient-friendly resources to support lasting behavior change. He closed by reminding the audience that while pharmaceuticals deliver rapid clearance, sustainable outcomes in psoriasis come from integrating medical, lifestyle, and supportive care in partnership with patients
Molluscum! Everything You Wanted to Know and More! | Speaker(s): Elizabeth Swanson, MD | Sunday, 08/24/25 | 9:30 AM - 10:00 AM MST | Summary by: Ajay Dulai
Dr. Swanson completed a lecture on molluscum and its treatments. It is caused by the pox virus, and manifests as itchy flesh-colored bumps. It is very common in children, but treatment is actually not required as they often self-relief in 2-3 years. She recommends that we inform parents of patients that there are no concerns of scarring or long-term health complications. This will often only affect patients once in their lifetime. Molluscum affecting the groin is common, and in the absence of other signs, does not suggest abuse.
There are a multitude of current treatments. Tea tree oil is a natural remedy, but can induce an eczematous rash. Imiquimod’s efficacy is controversial, but Dr. Swanson reports that she uses it in her practice with good efficacy. Candida antigen injections every 3-4 weeks, and it tends to take 3-5 treatments. Dr. Swanson recommends 3 treatments before progressing to a different treatment, and mild irritation can actually be a sign of a positive immune response. Potassium hydroxide 10% applied with a q-tip can be recommended, however irritation is a common adverse effect. Cantharadin has a 50% resolution after each treatment, but can cause blisters lasting for 3-4 days. Dr. Swanson recommends not to use this treatment in the intertriginous areas due to blister irritation. Curettage is an aggressive treatment which can cause scarring.
Dr. Swanson relies on the saying “the uglier they look the happier I am.” This represents a positive immune response suggesting that they are clearing. Ultimately, the choice of treatment regimen will be a shared decision between the provider, the patient, and parents.
Exercise and HS | Speaker(s): Hadar Lev-Tov, MD with David W Mandel, PT, MSPT, PhD | Sunday, 08/24/25 | 10:15 AM - 10:45 AM MST | Summary by: Gabriela Beraja
Drs. Hadar Lev-Tov and David Mandel highlighted the role of exercise as an anti-inflammatory intervention in hidradenitis suppurativa (HS) and encouraged clinicians to prescribe physical activity into care plans. Evidence from other chronic inflammatory diseases such as psoriatic arthritis shows that physical activity reduces systemic inflammation, improves well-being, and decreases disease activity through mechanisms including reductions in TNF-α and CRP and increases in IL-6 and IL-1 receptor antagonists. HS shares similar inflammatory pathways, but the specific effects of exercise on disease activity, lesion burden, and patient-reported outcomes in HS remain largely unstudied. Notably, there is a lack of research detailing which exercise types, intensities, or durations may be most beneficial for HS patients.
Preliminary data from an ongoing University of Miami clinical trial (generously funded by the HS Foundation) evaluating physical activity in individuals with HS were presented. Functional testing showed that patients with mild HS performed close to predicted norms on the six-minute walk test, chair stand test, and grip strength, whereas those with moderate to severe disease exhibited marked declines, particularly in mobility and endurance. A 12-week home-based resistance program targeting both upper and lower extremities yielded promising outcomes, with significant gains in chair stand performance and six-minute walk distance (p < .001). However, attrition was high, largely due to axillary pain and limited flexibility. Overall, these findings highlight that exercise is feasible and beneficial in HS, but disease-specific adaptations are essential to address barriers and should be incorporated into standard care.
Common Dermatological Manifestations of Gut Microbiome Imbalances | Speaker(s): Rubaina Dang, ND | Sunday, 08/24/25 | 10:45 AM - 11:15 AM MST | Summary by: Ajay Dulai
This session was led by Dr. Dang, who is a naturopathic doctor specializing in gut microbiome, and its implications within dermatology. The gut skin axis composes of microbial metabolites, barrier function, systemic inflammation, and neuroendocrine factors which can all impact both gut and skin. The most common skin conditions related to GI disorders are celiac disease, inflammatory bowel disease (IBD), small intestinal bacterial overgrowth (SIBO), rosacea, and H. pylori.
Dr. Dang recommends that celiac patients should not only be put on a gluten-free diet, but also incorporate omega-3 supplementation, antioxidant rich foods, probiotics (L. rhanmosus and B. longum), and prebiotic fibers. IBD can manifest in the skin as psoriasis pyooderma gangeronusum, and erythema nodosum. The integrative treatment of IBD should consist of curcumin, boswelia, glutamine, omega-3’s, and vitamin D. SIBO can present as a wide variety of skin conditions such as acne, rosacea, urticaria, atopic dermatitis, and psoriasis. Berberine has shown in previous research to be more effective than rifaxamin to treat SIBO. Dr. Dang also recommends including oregano oil, neem oil, and allicin. Similarly, H. pylori infection can be treated with integrative therapies with a better side effect profile than traditional triple therapy. Dr. Dang recommends mastic gum, berberine, bismuth, lactoferrin, zinc carnosine, and oregano oil. Gut microbiome testing is useful to assess gut health. Dr. Dang recommends testing which uses PCR testing as this provides a more accurate assessment based on DNA. She recommends connecting with the testing companies, such as GIMap, as they can help provide an overview of the test results.
Update on Alopecia Areata - An Integrative Perspective | Speaker(s): Apple Bodemer, MD | Sunday, 08/24/25 | 11:15 AM - 11:45 PM MST | Summary by: Ajay Dulai
Dr. Bodemer is an integrative dermatologist, and in this lecture focused on updated integrative approaches in treating alopecia areata. Alopecia areata is a nonscarring form of alopecia that affects about 2% of the world’s population. Multiple episodes are common, and can affect individuals at all stages of life. There is a genetic predisposition for the condition, but stress, drugs (adalimumab, dupilumab), and SARS-CoV-2 (infection and vaccine). It is associated with other autoimmune conditions such as thyroid dysfunction, vitiligo, and atopy. New research is suggesting that the gut microbiome can be implicated in the pathogenesis of alopecia areata. We are still currently understanding this connection, but there are published cases of fecal transplants improving the condition.
There is currently vagueness in the literature regarding the best diet for alopecia areata, but Dr. Bodemer screens all patients for gut disturbances, and recommends an anti-inflammatory and anti-oxidant diet. There have been cases of severe protein deficiency, so protein intake should be assessed in every patient. Dr. Bodemer recommends an essential oil blend as an adjunctive therapy: thyme, lavender, rosemary, cedarwood, jojoba, and grapeseed.
Novel medications have shown great promise as a primary therapy for alopecia areata. JAK-inhibitors are currently undergoing clinical trials, and can be used off-label. Second generation anti-histamines has shown to reduced substance P in the hair follicle, and can be a great adjunctive therapy. Photobiomodulation with UVB can locally suppress the immune response and has been shown to be beneficial in pilot studies.
Panel: Integrating Technology in Dermatology—Ultrasound, Glucose Monitoring, Wearables, and AI (DermGPT) | Speaker(s): Hadar Lev-Tov, MD | Sunday, 08/24/25 | 1:00 PM - 1:45 PM MST | Summary by: Ajay Dulai
Dr. Lev-Tov led a panel of four integrative practitioners as they discussed the implication of technology into dermatology. Integrative medicine leverages ancient experience, but it also concerns itself with advanced technologies. Clinicians spend roughly 5 hours of their 8 hour shift on electronic patient charts. DermGPT provides an automated method of triaging patients to cut down the admin time which clinicians experience and has been trained on dermatology-specific information, making it ideal for dermatologists.
When using artificial intelligence (AI) it is important to guide it with specific context, demographics, and type of output that is expected. If the AI does not give an appropriate answer, you can always re-prompt with more specific details. The panel provided an excellent example of the capabilities of DermGPT to triage three patients, but in a real dermatology practice, this will assist with hundreds of patients.
The panel provided another example of the advancements in ultrasound technology. To assist with integrating this in the common dermatology practice, portable ultrasounds can now connect wirelessly to phones or tablets. This is relevant to HS, as ultrasound can provide a deeper look into the tunnels which we cannot see with the naked eye. As another case of DermGPT, it assisted with creating the medical notes based on the ultrasound of a HS patient. This time the AI was asked to create the notes in a way to make sure that the patient met the criteria to be approved for future therapy.
Wearables are another integration of technology. The Oura Ring can provide clinicians a look into the patient’s sleeping habits. In this case, the data from the Oura Ring helped the clinician identify that a patient with atopic dermatitis was not sleeping well due to her disease. These wearables can now integrate seamlessly into electronic medical records, making this data easily accessible to the clinician. In another example, the clinician used DermGPT to create a handout about a diet which can help manage the patient’s acne. It is important to note that the AI did provide references to all information in the handout. Technologies can have an important role in improving medicine, and the application of it within dermatology continues to revolutionize how we manage patients.
* This blog is for general skin, beauty, wellness, and health information only. This post is not to be used as a substitute for medical advice, diagnosis, or treatment of any health condition or problem. The information provided on this Website should never be used to disregard, delay, or refuse treatment or advice from a physician or a qualified health provider.