Anuj Budhiraja
Ajay Dulai
Gili Amid
Aye Taba
Gabriela Beraja
Anuj Budhiraja
Ajay Dulai
Gili Amid
Aye Taba
Gabriela Beraja
Summary by: Gili Amid | Aye Taba | Ajay Dulai | Gabriela Beraja | Anuj Budhiraja
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
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.
Pigmentary Disorders Update | Speaker(s): Seemal Desai, MD FAAD | Friday, 08/22/25 | 9:30 AM - 10:00 AM MST | Summary by: Anuj Budhiraja
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.
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. 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.
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: Aye Taba
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.
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
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.
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
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.
* 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.
