Aye Taba
Valentina Caicedo
Fernando Salinas
Thursday, August 20, 2026 | DAY ONE
Skin Aging & Regenerative Medicine | Speaker(s): Raja Sivamani MD MS AP | Thu 08/20/26 - 1:00 PM - 1:30 PM PDT Summary by: Aye Taba
Dr. Raja Sivamani discussed skin aging and regenerative medicine through an “outside-in and inside-out” approach, emphasizing that healthy skin aging involves not only repairing and protecting the skin but also addressing systemic factors that influence aging. He highlighted photoprotection as a key preventive strategy and discussed bemotrizinol as a new broad-spectrum sunscreen ingredient in the U.S., while noting that additional protection against long UVA and visible light may still be needed. Antioxidants may provide another layer of protection, with emerging evidence supporting both oral approaches, such as cocoa flavanols and carotenoids, and topical antioxidant formulations. Dr. Sivamani also reviewed epigenetic clocks as tools for measuring biological aging and emphasized that current skin aging clocks remain limited because they do not adequately capture skin function. His group is working toward a more skin-specific biological clock that combines image-based aging with functional measures such as elasticity, hydration, and transepidermal water loss. He then shifted to the systemic drivers of aging, highlighting insulin resistance and inflammation as factors associated with accelerated biological aging. Importantly, insulin resistance may be present even when fasting glucose appears normal and has been associated with several dermatologic conditions, including acne, psoriasis, hidradenitis suppurativa, and androgenetic alopecia. He suggested that fasting insulin and glucose with calculation of HOMA-IR may provide additional insight beyond hemoglobin A1c alone. Practical strategies to improve insulin sensitivity included resistance training, post-meal activity, reducing simple carbohydrates, adequate protein intake, and eating protein or healthy fats before carbohydrates. Overall, the session emphasized that regenerative dermatology should extend beyond treating the visible signs of aging to addressing the underlying factors that influence skin and overall health.
Mitochondria and Skin Longevity: Clinical Insights | Jesse Schwartzberg, MD | Thu 08/20/26 1:30 PM - 2:00 PM PDT | Summary by: Aye Taba
Dr. Jesse Schwartzberg reframed mitochondria as more than the skin’s “power plants”: they also regulate repair, inflammation, collagen production, oxidative stress, and cell survival. With aging and UV exposure, mitochondrial dysfunction leads to less ATP, excess reactive oxygen species, impaired mitophagy, and inflammatory signaling, contributing clinically to wrinkles, pigmentary changes, slower wound healing, and loss of collagen and elastin. Damaged mitochondria can also release mitochondrial DNA, ATP, and proteins that act as distress signals to the immune system, promoting persistent low-grade “inflammaging.” UVA is particularly relevant in photoaging because dermal fibroblast mitochondria are a major target, linking mitochondrial fragmentation with reduced collagen production and proinflammatory cytokines. Emerging “mitochondrial dermatology” strategies aim to restore this balance through extracellular vesicles, targeted antioxidants, NAD+ support, photobiomodulation, and circadian or hormone-aligned approaches. Among antioxidants, topical melatonin may improve mitochondrial markers and dermal matrix organization, while CoQ10 has been associated with improved elasticity and reduced wrinkle depth. Urolithin A, a gut microbial metabolite derived after consumption of ellagitannins and ellagic acid, was highlighted for its potential to promote mitophagy, reduce oxidative stress and MMP-1, and increase type I collagen expression. Red and near-infrared photobiomodulation may support mitochondrial energy production through cytochrome c oxidase, with early studies showing increased ATP and procollagen and reduced UV-induced oxidative damage. Schwartzberg cautioned that strategies that boost NAD+ levels deserve particular care in patients with cancer concerns, and that much of the field still relies on small, short-term, or uncontrolled studies.
Precision Medicine Application to Dermatology | Anil Bajnath, MD | Thu, 08/20/26 2:00 PM - 2:30 PM PDT | Summary by: Fernando Salinas
The first key takeaway is that dermatology should be viewed through a systems biology framework, recognizing the skin as an active environmental interface influenced by genetic susceptibility, immune pathways, microbiology, metabolism, and lifestyle factors. Traditional morphology-based diagnoses remain essential, but similar clinical presentations may represent different upstream biological networks, helping explain variability in disease severity, progression, comorbidities, and treatment response. The second key takeaway is that precision medicine is a clinical reasoning framework rather than simply genetic testing. Its purpose is to integrate multiple biological layers to explain why patients with similar phenotypes may respond differently to the same therapy, complementing rather than replacing established diagnostic approaches. The third key takeaway is that genetic variation and epigenetic regulation provide important intermediary mechanisms linking environmental exposures to disease expression. Genetic variants often have modest individual effects but can interact across biological pathways and with environmental factors to produce different phenotypes. The fourth key takeaway is that the microbiome and mitochondrial function represent additional dynamic layers influencing immune regulation, metabolism, and inflammatory tone. Microbial communities continuously interact with host tissues and may contribute to barrier dysfunction and inflammatory processes. Finally, emerging multi-omics approaches—including transcriptomics, metabolomics, microbiome profiling, and environmental exposure assessment—may enable more individualized clinical decision-making. However, substantial limitations remain, including cost, accessibility, insurance coverage, and difficulty interpreting highly multidimensional datasets, highlighting the need for validated clinical applications and tools such as AI to translate complex biological information into actionable insights.
Alopecia Areata: Integrative Approaches to Severity Assessment and Systemic Therapy | Jennifer Soung, MD | Thu, 08/20/26 2:30 - 3:00 PM PDT | Summary by: Fernando Salinas
The presentation emphasized that alopecia areata (AA) is more than a disorder of hair loss; it is a chronic, unpredictable condition that can substantially affect patients’ confidence, identity, and quality of life. Diagnosis is often clinical, but careful examination of the scalp, eyebrows, eyelashes, and other hair-bearing areas is essential because AA can present with diverse patterns and may overlap with other forms of alopecia. When the diagnosis or pattern is unclear, scalp biopsy with both horizontal and vertical sections can help identify follicular changes and inflammation. Patient photographs can also provide valuable insight into disease progression and baseline severity. A major theme was that AA severity should be assessed multidimensionally rather than solely by the percentage of scalp hair loss. Psychosocial impact, eyebrow or eyelash involvement, rapid progression, and inadequate response to topical or intralesional therapy can all indicate clinically significant disease. Treatment decisions should therefore incorporate both objective disease burden and the individual patient’s goals. The emergence of JAK inhibitors has substantially expanded treatment options, with earlier treatment generally associated with better chances of meaningful hair regrowth. However, expectations must be carefully managed because responses can take months and vary by disease pattern and duration. Long-term management may require combination or maintenance therapies and individualized monitoring. Ultimately, Dr. Soung stressed that effective AA care extends beyond medication: understanding each patient’s story, validating psychosocial concerns, providing realistic timelines, and offering practical support are fundamental components of treatment.
Prurigo Nodularis (PN): Neuroimmune Mechanisms and Type 2 Inflammation | Sonal Choudhary, MD | Thu, 08/20/26 3:00 - 3:30 PM PDT | Summary by: Valentina Caicedo
Dr. Sonal Choudhary reframed prurigo nodularis (PN) as a neuroimmune disease rather than the benign, scratch-induced dermatosis it was long considered, describing it instead as an ongoing conversation between the immune system and sensory nerves that becomes self-sustaining. She emphasized interleukin-31 (IL-31) as the central bridge in this loop, as it is released by Th2 immune cells and acts directly on sensory neurons to trigger itch, which in turn drives more scratching and more inflammation. Periostin, produced by dermal fibroblasts stimulated by IL-13, was highlighted as a second key driver that activates itch nerves independently of histamine while also promoting the fibrosis that builds the nodule itself, helping explain why antihistamines are generally ineffective in this condition. Importantly, Dr. Choudhary stressed that PN is not simply nodular atopic dermatitis, as it shows greater TH22 and TH17 involvement, more dermal fibrosis, and a distinct pattern of nerve remodeling with fewer nerve fibers in the epidermis but more in the dermis. Recurrent somatic NOTCH1 mutations have also been identified in PN lesional skin and are absent in atopic dermatitis, pointing to Notch signaling as a possible future therapeutic target. She also emphasized that the burden of PN extends well beyond the skin, with associations including chronic kidney and liver disease, depression and anxiety, increased all-cause mortality, and an elevated risk of lymphoma, particularly cutaneous T-cell lymphoma, which supports closer surveillance in selected patients. Notably, patients consistently rank itch as their single greatest burden and describe it in terms such as “psychologically destabilizing,” underscoring a clear unmet treatment need. Two biologics are now approved, dupilumab, which blocks the broader type 2 axis, and nemolizumab, which targets IL-31 signaling directly on nerves, and Dr. Choudhary suggested choosing between them phenotypically, favoring dupilumab for lesion-dominant disease or comorbid atopic dermatitis and nemolizumab when rapid relief of sleep-disrupting itch is the priority. She reviewed a growing pipeline of mechanism-driven agents, including vixarelimab, barzolvolimab, oral JAK inhibitors, and neurokinin-1 receptor antagonists. Finally, she emphasized that these therapies work best within an integrative framework that also addresses the itch-scratch cycle behaviorally and incorporates modalities such as phototherapy, acupuncture, mind-body therapy, and gut-skin axis support, illustrated by a case in which a patient’s worst-itch score fell from 9 to nearly clear by week 16 on dupilumab with adjunctive dietary changes.
Advances in Vitiligo Management: Personalized Treatment Pathways and Emerging Therapies | James Song, MD | Thu, 08/20/26 3:30 - 4:00 PM PM PDT | Summary by: Valentina Caicedo
Dr. E. James Song described vitiligo as a failure of redox balance, in which oxidative stress damages melanocytes and triggers an immune attack that becomes self-reinforcing through interferon-gamma and JAK-STAT signaling, explaining why JAK inhibition works so well. He framed treatment around three sequential goals; stop the immune attack, restore pigment, and maintain repigmentation. He stressed that the first six to twelve months are largely about halting progression rather than seeing color return. He offered a practical checklist for every visit covering stability, subtype, extent, location, and quality of life, noting that quality of life impact does not track with body surface area. Importantly, Dr. Song characterized active vitiligo as a dermatologic emergency, with signs including new or enlarging lesions, confetti depigmentation, and Koebner phenomenon, and recommended photographs at every visit to track this reliably. He also emphasized that maintenance therapy is not optional, as tissue-resident memory T cells persist in previously affected skin and drive relapse in the same locations. Patience is essential with topical ruxolitinib, since responses at 52 weeks far exceed those at 24 weeks, and repigmentation depends heavily on hair follicle density, with the face responding well while hands and feet often do not. The systemic landscape is expanding rapidly, with upadacitinib approved in the EU and positive phase 3 results for povorcitinib and ritlecitinib, though he cautioned against cross-trial comparisons given differences in disease severity between study populations. Finally, he highlighted combination therapy with narrowband UVB as a way to deepen response, and IL-15-targeted agents as an emerging strategy aimed at durable remission off treatment.
Gut Feelings & GLP-1: Rewiring Metabolism Through the Microbiome and Probiotics | Michael Traub, ND | Thu, 08/20/26 4:00 PM - 4:30 PM PDT Summary by: Aye Taba
When a patient taking a GLP-1 receptor agonist develops persistent bloating, abdominal pain, constipation, or diarrhea, Dr. Michael Traub encouraged clinicians to ask whether it is truly an expected medication effect, or whether SIBO may be contributing. GLP-1 therapies delay gastric emptying and can slow small-intestinal transit and the migrating motor complex, creating a plausible environment for bacterial overgrowth, although current evidence supports an association rather than causation. A retrospective multicenter study involving 216,173 patients found increased short-term SIBO risk with GLP-1 or dual GLP-1/GIP receptor agonists, supporting symptom-driven evaluation in appropriate patients. Those with pre-existing motility problems, prior SIBO, diabetes with autonomic neuropathy, intestinal surgery, IBS, hypothyroidism, systemic sclerosis, Parkinson disease, or older age may be particularly susceptible. Breath testing can distinguish hydrogen-predominant SIBO from methane-associated intestinal methanogen overgrowth and hydrogen sulfide overgrowth, which have different symptom patterns and treatment considerations. Treatment may combine targeted antimicrobials with diet and restoration of motility, with recurrence prevention remaining especially important. Dr. Traub highlighted newer findings that an elemental diet may selectively reduce Candida and M. smithii without depleting normal commensals, while Iberogast may offer prokinetic, prebiotic, and gut-barrier benefits. For patients on GLP-1 therapy, persistent symptoms beyond the initial dose-escalation period should not automatically be dismissed as drug side effects; breath testing and attention to motility may help identify SIBO while avoiding unnecessary discontinuation of an otherwise beneficial therapy.
Tapping Into a New Reality: Integrating Emotional Freedom Technique and Hypnotherapy in Dermatology | Meena Julapalli, MD | Thu, 08/20/26 4:30 PM - 5:00 PM PDT Summary by: Fernando Salinas
The presentation highlighted the powerful relationship between emotional health and dermatologic disease, emphasizing that chronic stress can influence the skin through cortisol production, sympathetic nervous system activation, inflammation, and disruption of the skin barrier. Because conditions such as eczema and other chronic skin disorders can significantly affect sleep, relationships, school, work, and self-image, emotional distress may both result from and contribute to worsening disease. Dr. Julapalli encouraged clinicians to recognize these psychosocial dimensions and ask patients directly how their condition is affecting their lives. A major focus was on emotional freedom techniques (EFT), which combine cognitive reframing with stimulation of specific pressure points through tapping. The approach aims to reduce the emotional intensity associated with stressful memories or experiences by shifting attention away from judgment and toward acceptance. Dr. Julapalli also discussed hypnosis and guided relaxation as complementary mind-body techniques intended to help patients access and process unresolved emotional experiences while promoting a calmer physiologic state. Although these approaches were presented as adjunctive rather than replacements for conventional medical treatment, the speaker emphasized their potential value in helping patients manage stress, anxiety, pain, and other emotional factors that may influence chronic disease. Demonstrations illustrated how patients can assess emotional intensity before and after these exercises and use the techniques independently. Ultimately, the presentation advocated for a more integrative model of dermatologic care that addresses both physical symptoms and the emotional experiences underlying or accompanying chronic skin disease. Building trust, validating patients’ experiences, and empowering them with practical stress-regulation tools were emphasized as important components of holistic care.
Non-CME Interactive Case Discussion + Food as Medicine Demo | Raja Sivamani, MD MS AP + Chef Kimber Dean | Thu, 08/20/26 5:30 PM - 6:30 PM PDT Summary by: Fernando Salinas
The session opened by asking what longevity actually means, contrasting the essentialist, medicalist, and stoic perspectives, and landing on the point that most people are less interested in living longer than in living well. Diet was presented as one of the most powerful available levers, with evidence suggesting that eating well can add up to roughly ten years of life. The demonstration centered on a butternut squash stew, which was used to illustrate that heat helps extract carotenoids and make them more bioavailable, though excessive cooking begins to break them down. Purple sweet potato was highlighted for its ability to activate NRF2, a key regulator of the body’s antioxidant response, while sweet potato more broadly was discussed for its role in supporting pancreatic function and blood sugar regulation. Quinoa balls were also prepared, reinforcing protein as the second nutritional pillar alongside carotenoids. Notably, higher blood carotenoid levels have been associated with biological age deceleration on epigenetic clocks such as GrimAge and PhenoAge, providing a measurable link between what is on the plate and how the body ages. The overarching message was that nutrition for longevity has to be enjoyable and taste good to be sustainable.
Friday, August 21, 2026 | DAY TWO
Skin Doesn’t Lie: Acne, Hirsutism, Menopause, and the New PMOS Revolution | Speaker(s): Sahar Swidan, PharmD, ABAAHP, FAARFM, FACA | Date/Time: Fri, 08/21/26 9:00 AM - 10:00 AM PDT | Summary by: Aye Taba
Dr. Sahar Swidan encouraged dermatologists to look beyond the visible skin finding, as acne, hirsutism, hair loss, dryness, and accelerated aging may be early signs of hormonal or metabolic dysfunction. Because the skin can locally metabolize hormones, normal serum testosterone does not always rule out androgen-driven disease; free androgen activity, SHBG, insulin, and tissue sensitivity may better explain the phenotype. One of her strongest practical recommendations was to add fasting insulin to metabolic evaluation, since hyperinsulinemia lowers SHBG, increases free androgen activity, and can contribute to acne and hirsutism before overt diabetes develops.
She also emphasized the gut–hormone connection through the estrobolome and recommended adequate soluble and insoluble fiber, around 35 g/day, particularly when managing hormones. Her memorable rule for estrogen detoxification was to work Phase 3 → Phase 2 → Phase 1, support elimination and fiber first, then methylation/conjugation pathways, before adding Phase 1 agents such as DIM when indicated. For patients with skin or hair changes, cold intolerance, or constipation suggestive of thyroid dysfunction, she advised looking beyond TSH alone and considering free T3, free T4, and thyroid antibodies, since impaired T4-to-T3 conversion may be missed.
In menopause, estrogen loss contributes to dryness, thinning, and reduced collagen, while melatonin was highlighted for its broader antioxidant, UV-protective, repair, and hair-related effects beyond sleep. Dr. Swidan also discussed low-dose naltrexone (LDN) as a low-toxicity option for selected inflammatory dermatoses and refractory itch, while acknowledging that the evidence remains mostly from small studies and case series. In men, she cautioned against viewing age-related skin changes as simply a testosterone deficiency, since impaired androgen-receptor signaling in aging fibroblasts may limit the skin response even when testosterone is replaced.
Regional Eczemas: An Update and Integrative Approach | Speaker(s): Peter Lio, MD | Date/Time: Fri, 08/21/26 - 10:00 AM - 10:30 AM PDT | Summary by: Valentina Caicedo
Dr. Peter Lio framed atopic dermatitis as a disease rooted in epithelial barrier failure, citing the barrier hypothesis that detergents, pollution, microplastics, and food emulsifiers have damaged the linings of the skin, airway, and gut. He emphasized epicutaneous sensitization, summarized in the line that through the skin allergies begin while through the diet allergies stay quiet, since exposure across a disrupted barrier drives allergy whereas oral exposure promotes tolerance. Treatment goals were framed simply as getting clear, keeping clear safely, and keeping it up, with maintenance being the step most often lost. He reviewed an expanding nonsteroidal topical landscape including calcineurin inhibitors, roflumilast, tapinarof, ruxolitinib, and delgocitinib, and noted that dupilumab and tralokinumab both shift the skin microbiome toward healthier flora by reducing Staphylococcus aureus. Turning to regional disease, he discussed head and neck dermatitis, which typically flares around puberty and implicates sebum and Malassezia, supporting a trial of antifungal therapy. He distinguished this from dupilumab-associated face and neck dermatitis and walked through a broad differential including allergic contact dermatitis, rosacea, demodicosis, and topical corticosteroid withdrawal, which now has formal Delphi-derived diagnostic criteria. Notably, he highlighted black tea compresses for facial dermatitis as a simple and inexpensive intervention that improved facial EASI and itch within three to six days. For hand eczema he stressed that most cases involve overlapping subtypes and reviewed newer targeted options alongside non-pharmacologic measures such as barrier creams, paraffin baths, and narrowband UVB.
Clinical Case Review and Interactive Discussions | Speaker(s): James Song, MD | Apple Bodemer, MD | Date/Time: Fri, 08/21/26 11:30 AM - 12:30 AM PDT | Summary by: Fernando Salinas
This session emphasized an integrative approach to inflammatory skin disease, using interactive patient cases to demonstrate how conventional dermatologic treatments can be combined with lifestyle modifications, supplements, phototherapy, and emerging topical therapies. In vitiligo, oxidative stress and immune dysregulation were highlighted as important therapeutic targets. While no specific diet has been definitively shown to treat vitiligo, antioxidants such as vitamin B12, folate, alpha-lipoic acid, vitamins C and E, and other antioxidant combinations may provide additional benefit, particularly when combined with phototherapy. Metabolic abnormalities, including insulin resistance and metabolic syndrome, were also associated with vitiligo severity. Narrowband UVB was emphasized as an effective and relatively safe treatment that may offer benefits beyond repigmentation through immune modulation and other systemic effects, although treatment accessibility and frequent office visits remain important barriers. Home phototherapy may improve adherence and convenience for appropriate patients. The second case focused on severe, treatment-fatigued atopic dermatitis and reinforced the importance of shared decision-making and rebuilding patient trust. Emerging nonsteroidal options targeting Staphylococcus aureus colonization, oxidative stress, inflammation, and itch were discussed, alongside topical vitamin B12, indigo naturalis, strontium-containing products, dietary approaches, and lifestyle interventions. Importantly, these therapies were presented as complementary rather than replacements for evidence-based systemic treatments. The session’s overarching message was that successful care requires addressing multiple disease mechanisms while also understanding the patient’s prior experiences, preferences, and treatment concerns to develop a realistic, individualized plan.
The Biology of Beauty Sleep: How Sleep and Stress Affect Skin Health | Speaker(s): Aric Prather, PhD | Date/Time: Fri, 08/21/26 1:30 PM - 2:00 PM PDT | Summary by: Fernando Salinas
This session highlighted sleep as a fundamental but often underrecognized determinant of overall health and dermatologic disease. Sleep is a dynamic process regulated by both circadian rhythms and homeostatic sleep pressure, with normal architecture changing across the lifespan through increased awakenings and reduced deep sleep. Chronic insufficient or disrupted sleep has been associated with increased risks of depression, anxiety, cardiovascular disease, infection, and systemic inflammation. Dr. Prather emphasized the relationship between sleep and inflammatory skin conditions, although much of the existing evidence remains observational. Patients with atopic dermatitis and psoriasis appear more likely to experience poor sleep quality, and a small polysomnography study found that individuals with psoriasis had poorer sleep efficiency, greater wakefulness during the night, and reduced REM sleep compared with healthy controls; sleep disruption also correlated with psoriasis severity. Inflammation may represent an important biological link, as experimental sleep deprivation has been associated with increased proinflammatory markers, including IL-6 and C-reactive protein. This relationship may also be bidirectional, with inflammation and skin disease further disrupting sleep. Management therefore requires more than simply recommending “sleep hygiene.” Cognitive behavioral therapy for insomnia (CBT-I), considered a first-line treatment for chronic insomnia, incorporates sleep scheduling, stimulus control, relaxation training, cognitive restructuring, and time-in-bed restriction, with substantial improvements reported in many patients. The session concluded that dermatologists should routinely discuss sleep with patients, as improving sleep may represent an accessible opportunity to improve inflammation, stress management, quality of life, and potentially dermatologic outcomes.
The Little Mast Cell That Could: Pathophysiologic Foundations in Urticaria | Speaker(s): Naiem T. Issa, MD, PhD | Date/Time: Fri, 08/21/26 2:00 PM - 2:30 PM PDT | Summary by: Aye Taba
Dr. Naiem Issa used the mast cell as the centerpiece for understanding why chronic spontaneous urticaria (CSU) can be so heterogeneous, and why antihistamines may address only part of the disease. Mast cells release not only histamine, but also tryptase, cytokines, leukotrienes, prostaglandin D2, and platelet-activating factor, helping explain incomplete responses to histamine blockade alone. He described “many roads” to mast-cell degranulation, including type I autoallergy, type IIb autoimmunity, complement, PAR1/PAR2, and MRGPRX2 signaling. BTK is an important convergence point for both IgE- and IgG-mediated pathways, while MRGPRX2 provides a separate route triggered by neuropeptides, eosinophil mediators, and certain medications, highlighting the neuroimmune “ping-pong” that may perpetuate CSU. Type 2 inflammation adds another layer, with IL-4 and IL-13 sensitizing the vasculature and influencing mast-cell function.
A particularly useful clinical pearl was that CSU-related angioedema can occur around joints, causing painful, non-pitting swelling that can mimic inflammatory arthritis but remains extra-articular, with swelling occurring alongside active urticarial flares. CSU can also produce surprisingly “lupus-like” laboratory findings: ANA positivity, anti-dsDNA antibodies, and low complement may occur, with ANA reported in 31% of one CSU cohort. Dr. Naiem therefore distinguished testing to evaluate comorbidities and differential diagnoses from indiscriminate allergy testing, noting that he checks for thyroid disease in CSU rather than using thyroid testing to establish the CSU diagnosis.
Inflammatory Vulvar Dermatoses: Integrative Management Beyond Steroids | Speaker(s): Pooja R. Shah, MD, FAAD | Date/Time: Fri, 08/21/26 2:30 - 3:00 PM PDT | Summary by: Valentina Caicedo
Dr. Pooja Shah argued that topical steroids, while essential, are only one part of vulvar care, since patients often remain symptomatic after visible inflammation clears because irritant overlap, neuropathic pain, and pelvic floor dysfunction coexist. She emphasized a hidden burden of underreporting and misdiagnosis driven by stigma and a visual literacy gap in skin of color, urging a shift from an “erythema-centric” to a “texture- and pigment-centric” lens. For lichen sclerosus, she stressed that maintenance therapy is mandatory to prevent scarring and squamous cell carcinoma, and highlighted the vitiligoid variant that mimics vitiligo but warrants biopsy if there is itch or scarring. She distinguished lichen planus by its vaginal involvement and erosive predominance, noting that about half of women with oral lichen planus have undiagnosed vulvovaginal disease. Vulvar psoriasis was characterized as lacking scale because friction rubs it off, appearing violaceous rather than red in skin of color, and neither involving mucosa nor scarring. On contact dermatitis, she noted irritant reactions outnumber allergic ones and reminded clinicians to ask about the sexual partner’s products as well as the patient’s. Notably, she framed vulvodynia and pelvic floor dysfunction as overlapping with inflammatory disease rather than replacing it, cautioning that persistent pain does not mean the inflammation was imaginary, and advocating early pelvic floor physical therapy referral. She highlighted that vulvar hidradenitis suppurativa carries the longest diagnostic delay of any vulvar dermatosis because it is repeatedly mislabeled as recurrent Bartholin cysts, with Black patients facing both higher prevalence and longer delays. Her most practical contribution was a set of recalibration rules: if it looks like vitiligo but itches or scars it is lichen sclerosus, if it is plum-colored and shiny without scale it is psoriasis, and if a “cyst” recurs twice in the same spot it is hidradenitis suppurativa. She closed by calling for biopsy of any non-healing ulcer and for research addressing the near-absence of skin of color data in vulvar dermatology
Hidradenitis Suppurativa: Pain, Lifestyle, and Integrative Interventions | Speaker(s): Steve Daveluy, MD | Date/Time: Fri, 08/21/26 3:00 PM - 3:30 PM PDT | Summary by: Valentina Caicedo
Dr. Steve Daveluy framed HS management as three overlapping domains; medical therapy, surgery, and lifestyle modification. He emphasized a “window of opportunity” in which early treatment prevents irreversible tissue destruction, since longer diagnostic delay predicts poorer response to biologics. On diet, he reviewed evidence that higher Mediterranean diet adherence correlates with lower severity, that intermittent fasting improved severity independent of weight loss, and that most patients avoiding brewer’s and baker’s yeast improved, with the majority flaring within days of rechallenge. He also highlighted emerging retrospective data showing GLP-1 receptor agonists improved severity, flare frequency, pain, and quality of life at six months. Among supplements, he noted that HS patients carry much higher odds of low zinc, that zinc gluconate alone or with nicotinamide improved severity and pain, and that vitamin D deficiency is nearly universal with supplementation reducing nodules. Importantly, he stressed the mental health burden of HS, offering a practical script asking patients’ permission to discuss it, alongside breathing and self-compassion exercises and support group referral. On pain, he urged clinicians to distinguish nociceptive pain, described as aching or gnawing, from neuropathic pain, described as burning, since the latter responds to duloxetine or gabapentin rather than escalating analgesics. He reviewed cannabinoids as a plausible adjunct acting on CB1 receptors to diminish excitation of cutaneous C-fibers. Notably, he argued dermatologists should perform more in-office procedures for persistent lesions, reviewing ultrasound-assisted intralesional triamcinolone, deroofing and punch debridement with secondary intention healing, cryoinsufflation, and laser hair removal, which works best with Nd:YAG in early disease. His closing pearls were to send patients home with a diet handout, consider zinc and vitamin D, address mental health directly, and reach for procedures rather than repeated incision and drainage.
Natural Regeneration of the Aging Face: What Acupuncture and Traditional Chinese Medicine Can Teach Us About Facial Aging | Speaker(s): Sandra Lanshin Chiu, L.Ac. | Date/Time: Fri, 08/21/26 3:30 PM - 4:00 PM PDT | Summary by: Fernando Salinas
This session presented a traditional Chinese medicine approach to facial aging that emphasizes treating the whole person rather than focusing exclusively on visible changes in the face. The speaker described facial aging as potentially reflecting deeper disturbances in circulation, posture, stress, fluid regulation, and overall internal health. Concepts such as qi, blood, yin and yang balance, and organ-system function were used to connect external skin findings with internal patterns of dysfunction. Treatment modalities included acupuncture, electrostimulation, gua sha, cupping, moxibustion, and herbal therapy. Two patient cases illustrated this approach. In both, facial puffiness, loss of jawline definition, neck bulk, muscle tension, and forward-head posture were assessed alongside systemic symptoms such as stress, poor sleep, digestive complaints, and bloating. Rather than beginning treatment directly on the face, the speaker often focused first on releasing tension and improving mobility in the back and neck, with the goal of improving circulation and tissue movement throughout the body. In the first case, reducing posterior-chain and neck tension was associated with improved posture, sleep, anxiety, neck contour, and facial definition. The second case emphasized the potential relationship between facial puffiness and digestive symptoms within the TCM framework.The central message was that facial sagging and puffiness may not simply be consequences of gravity or aging but can be influenced by posture, chronic muscular tension, stress, and systemic factors. Preliminary studies discussed suggested that gua sha, acupuncture, and cupping may affect muscle stiffness, facial contour, and tissue perfusion. However, the speaker acknowledged that research directly evaluating these integrated approaches remains limited.
Turning Down the Heat in HS: Translating Emerging Mechanistic Insights and Biologic Innovation Into Meaningful Patient Outcomes | Speaker(s): Steve Daveluy, MD | Venessa Peña-Robichaux, MD | Date/Time: Fri, 08/21/26 5:30 PM - 6:30 PM PDT | Summary by: Aye Taba
The science of HS was paired with something equally important in this session: what it actually feels like to live with the disease. A patient living with HS shared his decades-long journey from painful lesions beginning around puberty, being treated for acne and folliculitis, antibiotics and surgeries, to finally finding an HS specialist, and later a biologic that he described as life-changing, giving him back freedom from a disease that had been dictating his life. His experience reinforced Drs. Daveluy and Peña-Robichaux’s call for earlier recognition based on characteristic lesions, typical locations, and recurrence, before irreversible tunnels and scarring accumulate. Mechanistically, HS evolves from follicular inflammation and rupture toward tunnel-driven disease with complex innate and adaptive immune signaling, including TNF-α and IL-17 pathways, creating a potential window where earlier effective treatment may prevent permanent damage. Treatment has also moved far beyond repeated antibiotics: adalimumab, secukinumab, and bimekizumab are approved biologic options, with additional targets including JAK1, BTK, IL-36, IL-1, and IL-17A/F under investigation. For established tunnels, medical control and procedures such as deroofing can work together rather than being viewed as competing approaches. Given the systemic and multidimensional burden of HS, multidisciplinary care integrating dermatology, surgery, pain management, behavioral health, and other specialties as needed is essential for comprehensive disease management. The patient’s perspective brought the treatment goal back to what matters in daily life: success may not mean perfectly clear skin, but less pain, drainage, odor, and disruption, and enough control to live life without HS making every decision.
Saturday, August 22, 2026 | DAY THREE
The Science of Coffee Session | Speaker(s): Raja Sivamani MD MS AP + Kraig Lee | Date/Time: Sat, 08/22/26 8:00 AM - 8:30 AM PDT | Summary by: Fernando Salinas
This session explored coffee as both an agricultural product and a potential contributor to human health, highlighting how coffee species, varieties, cultivation, processing, roasting, and preparation can influence its flavor and chemical composition. The speakers emphasized that coffee is highly diverse, with different varieties—including SL34 and Laurina—demonstrating substantial differences in caffeine and polyphenol content. Coffee processing methods, such as washed, natural, and honey processing, can further affect flavor and potentially preserve different bioactive compounds. Roasting also alters coffee chemistry: caffeine content remains relatively stable, while chlorogenic acids decline with darker roasting, although other antioxidant compounds may be formed or become more accessible.The discussion also highlighted emerging opportunities to utilize previously discarded parts of the coffee plant. Coffee leaves and fruit byproducts contain bioactive compounds and polyphenols, with preliminary analyses suggesting that certain varieties may have particularly high concentrations. The speakers described ongoing efforts to develop coffee-leaf tea and explore whether these agricultural byproducts could be incorporated into other industries. From a health perspective, observational studies discussed suggest that moderate coffee consumption, particularly approximately three to four cups daily, is associated with lower all-cause and cardiovascular mortality and may also support metabolic health. The speakers also discussed potential benefits related to skin aging and sun sensitivity. Importantly, preparation matters: the potential benefits observed in studies were emphasized primarily in black coffee, while added sugar and calorie-dense creamers may diminish its overall metabolic advantages. The session concluded that coffee is a complex plant whose agricultural diversity and bioactive compounds warrant further investigation.
Clinical Case Review and Interactive Discussions | Speaker(s): Raja Sivamani MD MS AP and Peter Lio, MD | Date/Time: Sat, 08/22/26 8:30 AM - 9:30 AM PDT | Summary by: Aye Taba
Drs. Raja Sivamani and Peter Lio used clinical cases to highlight practical, integrative approaches to two increasingly common concerns: hair loss associated with GLP-1 therapies and sensitive skin. Dr. Sivamani discussed diffuse hair shedding after rapid weight loss on GLP-1 therapy, emphasizing that the mechanism is likely multifactorial, including telogen effluvium from weight loss and nutritional changes and possible unmasking of underlying androgenetic alopecia. He stressed taking patients’ perceived thinning seriously even when density appears normal, evaluating the pattern and inflammatory signs, and reviewing weight loss, diet, protein intake, and supplements. He also highlighted biotin interference with laboratory testing and recommended holding it before labs. Management should be multifactorial rather than reflexively treating presumed androgenetic alopecia, with adequate protein/fiber intake, minoxidil when appropriate, and targeted nutraceutical support. He presented prospective data showing improvements in hair-growth measures with a multi-targeted nutraceutical, including among a small subgroup using GLP-1 therapies. Dr. Lio framed sensitive skin as a spectrum involving barrier dysfunction, inflammation, and neurosensory hypersensitivity. His key clinical message was to listen carefully, identify each patient’s dominant phenotype and triggers, and rebuild tolerance gradually with gentle, individualized skin care rather than trying multiple products at once. Mild cleansing, barrier support, and attention to environmental exposures were emphasized as meaningful components of management.
Epidermolysis Bullosa | Speaker(s): Lawrence Eichenfield, MD | Date/Time: Sat, 08/22/26 10:30 AM - 11:00 AM PDT | Summary by: Aye Taba
Dr. Lawrence Eichenfield reviewed epidermolysis bullosa (EB) as a group of inherited mechanobullous disorders with substantial morbidity, emphasizing recessive dystrophic EB (RDEB) and the importance of looking beyond the skin. In RDEB, loss-of-function mutations in COL7A1 impair type VII collagen and anchoring fibrils, resulting in skin fragility, recurrent blistering, chronic wounds, fibrosis, scarring, infection, and malnutrition. Because EB subtypes can have overlapping clinical presentations, he emphasized that genomic-based diagnosis is now the standard, rather than relying on phenotype alone. A major clinical concern is the development of early and potentially fatal cutaneous squamous cell carcinoma (SCC), particularly in severe RDEB, where chronic nonhealing wounds require close surveillance. Management therefore needs to be multidisciplinary and holistic, with attention to minimizing trauma, optimizing wound healing, preventing infection, nutrition, and psychological and social support, as well as monitoring gastrointestinal, dental, respiratory, hematologic, cardiac, orthopedic, genitourinary, and neuropsychiatric complications. Dr. Eichenfield particularly stressed nutrition as a critical component of healing and overall care, noting that even highly advanced therapies may have limited impact if the patient’s broader multisystem needs are not addressed. He also highlighted the rapidly evolving treatment landscape, including beremagene geperpavec (Vyjuvek), a topical HSV-1–based gene therapy that delivers COL7A1 to restore functional type VII collagen, as well as birch triterpenes (Filsuvez) for wound healing and gene-corrected autologous epidermal sheets with evidence of multi-year wound healing. Despite these advances, his overarching message was that EB remains a complex multisystem disease: emerging gene-directed and wound-healing therapies should complement, rather than replace, comprehensive supportive care.
The Effect of Excess Weight on Skin Inflammation and Disease | Speaker(s): Ganary Dabiri, MD PhD | Date/Time: Sat, 08/22/26 11:00 AM - 11:30 AM PDT | Summary by: Aye Taba
Dr. Ganary Dabiri asked dermatologists to consider what may be happening beyond the skin when treating inflammatory disease, particularly the role of excess adiposity and insulin resistance. Adipose tissue is metabolically active, and as it expands, it can shift toward a pro-inflammatory state with increased cytokine signaling and decreased adiponectin, potentially contributing to inflammation, impaired wound healing, and several chronic skin diseases. One of her most practical points was that insulin resistance may be present even when hemoglobin A1c is normal. She highlighted fasting glucose and fasting insulin to calculate the homeostatic model assessment of insulin resistance as a way to identify insulin resistance earlier in appropriate patients. Her cases made this especially tangible: patients with hidradenitis suppurativa, psoriasis, acne, and acanthosis nigricans sometimes had elevated insulin resistance despite otherwise reassuring metabolic testing. Across several cases, addressing excess weight and insulin resistance alongside dermatologic treatment was associated with improvements in skin flares, pain, joint symptoms, and quality of life. Dr. Dabiri also discussed emerging evidence that incretin receptor agonists may have anti-inflammatory effects beyond weight reduction, while emphasizing that her patients also receive nutrition counseling and guidance on physical activity. Just as important was how clinicians approach the conversation: ask permission to discuss weight, communicate with empathy, collaborate with patients, and use people-first language, “a patient with obesity,” rather than “an obese patient.”
Skin Cancer and Actinic Damage: Integrative Photoprotection | Speaker(s): Neal Bhatia, MD | Date/Time: Sat, 08/22/26 11:30 AM - 12:00 PM PDT | Summary by: Aye Taba
Dr. Neal Bhatia framed integrative photoprotection as more than sunscreen alone, combining effective UV and visible-light protection with strategies for photoaging, actinic damage, and skin cancer prevention. He emphasized maintaining evidence-based efficacy while considering patient preferences, cautioned against homemade sunscreens and misinformation, and discussed mineral and tinted sunscreens as well as emerging filters such as bemotrizinol. For photoaging, he reviewed retinol and bakuchiol, highlighting bakuchiol as a potentially better-tolerated alternative with retinol-like effects. A major focus was management of actinic keratoses and field cancerization, including cryotherapy, PDT, topical therapies, and particularly short-course calcipotriol plus 5-fluorouracil, which combines field treatment with TSLP-mediated antitumor immunity and has been associated with reduced subsequent SCC risk. He also reviewed tirbanibulin, systemic and topical chemopreventive approaches, including retinoids, nicotinamide, capecitabine, and diclofenac, and emerging therapies for nonmelanoma skin cancer. The session ultimately emphasized a multimodal approach: prevent ongoing photodamage, treat the cancerized field, reduce future keratinocyte carcinoma risk, and keep dermatologists actively involved as skin cancer management expands beyond procedural treatment.
Pediatric Skin Care - Acne | Speaker(s): Lawrence Eichenfield, MD | Date/Time: Sat, 08/22/26 2:00 PM - 2:30 PM PDT | Summary by: Fernando Salinas
This session reviewed the broad spectrum of acne and acneiform eruptions from infancy through adolescence, emphasizing the importance of age, morphology, and underlying hormonal status in guiding diagnosis and management. In neonates, acneiform eruptions are often self-limited and may be driven by maternal hormonal stimulation and increased sebaceous activity; neonatal cephalic pustulosis can overlap clinically with seborrheic dermatitis and does not require aggressive acne treatment. Infantile acne, however, is characterized by true comedones and inflammatory lesions and may persist longer, occasionally causing scarring or pigmentary changes. Standard acne therapies can be used when appropriate, while severe or refractory cases may require systemic treatment. Dr. Eichenfield also stressed that acne developing between approximately 1 and 7 years of age warrants greater concern for pathological androgen excess and should prompt evaluation for conditions such as premature adrenarche, congenital adrenal hyperplasia, Cushing syndrome, adrenal tumors, or precocious puberty. Growth velocity, bone age, virilization, and endocrine testing can help identify the underlying cause. Several mimickers were also discussed, including pseudo acne of the nasal crease, pediatric rosacea, aseptic granulomas, and fibrofollicular or angiofibroma-like papules of the nose that may occur in adolescents with acne. Treatment should therefore be tailored to the underlying diagnosis and severity rather than following a rigid stepwise approach. The session concluded with updates on isotretinoin, combination topical therapies, and hormonal treatment, emphasizing evidence that standard isotretinoin dosing does not appear to reduce final adult height and that cumulative exposure is more important than daily dose for reducing relapse.
Collaborative Care in Psoriatic Disease | Speaker(s): Tina Bhutani, MD; Michael Lewitt, MD | Date/Time: Sat, 08/22/26 2:30 PM - 4:30 PM PDT | Summary by: Fernando Salinas
Dr. Tina Bhutani opened with an overview of psoriatic disease, reviewing its clinical subtypes, epidemiology, and disparities by race and skin tone, and underscored its systemic nature—linking it to psoriatic arthritis, metabolic syndrome, cardiovascular disease, and profound quality-of-life burden comparable to major illnesses. Dr. G. Michael Lewitt surveyed the systemic treatment landscape, comparing biologic and oral classes (TNF, IL-12/23, IL-17, IL-23, TYK2, IL-23R, PDE4) by efficacy, safety, and patient-specific considerations, and outlined practical approaches to switching therapies after primary or secondary failure. Dr. Michael Richter reframed psoriatic arthritis as an overreaction to mechanical stress at the enthesis, driven by IL-23/IL-17/TNF signaling, and detailed where enthesitis manifests—nails, dactylitis, tendons, spine—while ranking treatment classes by efficacy and emphasizing early screening tools like PEST. Dr. Brigid Boland examined the intersection of IBD and psoriasis, highlighting shared genetic pathways, the phenomenon of TNF-inhibitor-induced paradoxical psoriasis, the failure of IL-17 blockade in Crohn’s disease, and the growing preference for IL-23 inhibitors as a therapy effective across both conditions. Danielle Cahalan focused on nutrition, presenting evidence that obesity and insulin resistance correlate strongly with psoriasis severity, and that Mediterranean dietary patterns—rich in omega-3s, polyphenols, and fiber while limiting alcohol, sodium, and saturated fat—alongside blood-sugar-stabilizing strategies can meaningfully improve outcomes. Dr. Raja Sivamani closed with obesity, the gut microbiome, and GLP-1/GIP agonists, showing that gut dysbiosis and intrahepatic fat drive psoriasis severity, and that weight-loss medications like tirzepatide significantly reduce PASI scores—though muscle loss risks require pairing therapy with protein intake and resistance training.
Skincare Through the Ages: Age-Appropriate Care from Adolescence to Menopause | Speaker(s): Ted Lain, MD MBA, FAAD | Jennifer Ornelas, MD | Heather Woolery-Lloyd, MD | Glynis Ablon, MD | Date/Time: Sat, 08/22/26 4:30 PM - 5:30 PM PDT | Summary by: Fernando Salinas
Dr. Jennifer Ornelas opened with skincare for tweens and teens, cautioning against the “Sephora Kids” trend of multi-step routines that risk barrier disruption and irritant dermatitis, and recommending simple regimens (gentle cleanser, moisturizer, sunscreen), evidence-based diet patterns for acne, and practical counseling scripts for parents navigating social-media-driven product demands. Dr. Heather Woolery-Lloyd covered Gen Z and Millennial skincare, contrasting Gen Z’s preventive, minimalist, ingredient-transparent approach with Millennials’ multi-step, high-performance routines, and reviewed the evidence behind antioxidants, AHA/BHA/PHA acids, and newer gentler retinoid alternatives (hydroxypinacolone retinoate, adapinoid, and bakuchiol) that rival retinol’s efficacy with less irritation. Dr. Glynis Ablon addressed menopause and the skin, detailing how estrogen decline drives collagen loss, thinning, and reduced elasticity; presenting meta-analysis data showing hormone therapy meaningfully restores skin thickness and elasticity in appropriate candidates; and introducing “Ozempic face” as an emerging concern from GLP-1-driven rapid weight loss, requiring a staged regenerative protocol (energy-based devices, biostimulators, fat grafting) paired with adequate protein intake. Dr. Ted Lain closed with a framework for building a regimen—AM protect, PM repair—reviewing the UV/visible-light spectrum and oxidative stress, the newly FDA-approved broad-spectrum filter bemotrizinol, the role of advanced glycation end-products in accelerating skin aging, and forward-looking innovations including mRNA-based collagen-replacement therapy and genomics/AI-driven “longevity cosmeceuticals” targeting the reversible hallmarks of skin aging.
Turning Down the Heat in HS: Translating Emerging Mechanistic Insights and Biologic Innovation Into Meaningful Patient Outcomes | Speaker(s): Steve Daveluy, MD | Venessa Peña-Robichaux, MD | Date/Time: Fri, 08/21/26 5:30 PM - 6:30 PM PDT | Summary by: Aye Taba
The science of HS was paired with something equally important in this session: what it actually feels like to live with the disease. A patient living with HS shared his decades-long journey from painful lesions beginning around puberty, being treated for acne and folliculitis, antibiotics and surgeries, to finally finding an HS specialist, and later a biologic that he described as life-changing, giving him back freedom from a disease that had been dictating his life. His experience reinforced Drs. Daveluy and Peña-Robichaux’s call for earlier recognition based on characteristic lesions, typical locations, and recurrence, before irreversible tunnels and scarring accumulate. Mechanistically, HS evolves from follicular inflammation and rupture toward tunnel-driven disease with complex innate and adaptive immune signaling, including TNF-α and IL-17 pathways, creating a potential window where earlier effective treatment may prevent permanent damage. Treatment has also moved far beyond repeated antibiotics: adalimumab, secukinumab, and bimekizumab are approved biologic options, with additional targets including JAK1, BTK, IL-36, IL-1, and IL-17A/F under investigation. For established tunnels, medical control and procedures such as deroofing can work together rather than being viewed as competing approaches. Given the systemic and multidimensional burden of HS, multidisciplinary care integrating dermatology, surgery, pain management, behavioral health, and other specialties as needed is essential for comprehensive disease management. The patient’s perspective brought the treatment goal back to what matters in daily life: success may not mean perfectly clear skin, but less pain, drainage, odor, and disruption, and enough control to live life without HS making every decision.
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.
