Podcasts

podcasts page features a feed of medical news and interview podcast series, including DocTalk, Lungcast, Derm Discussions, Rare Disease Report, and Heart Trials.

 host Brad Glick, DO, invited Brett King, MD, PhD, Yale School of Medicine, to the program to discuss an emerging class of dermatology therapy known as Janus kinase (JAK) inhibitors.

At the time, small molecule drugs such as upadacitinib (Rinvoq) were approved for the treatment of conditions like rheumatoid arthritis and ulcerative colitis.

Since then, updacacitinib and abrocitinib (Cibinqo) have been approved for use in patients with atopic dermatitis, a skin condition that affects up to 7.3% of adults in the United States alone.

Janus kinase inhibitors modulate the activity of multiple cytokine drivers of atopic dermatitis, and are supported by a variety of positive clinical trial results.

 to provide insight into the role JAK inhibitors play in the ever-growing armamentarium against atopic dermatitis.

King noted that many of the conversations regarding JAK inhibitors relate to the prescribing information of these therapies.

Most JAK inhibitor treatments are recommended for adults with refractory moderate to severe atopic dermatitis whose disease is not adequately controlled by other systemic drug products such as dupilumab.

“Because dupilumab is only rarely inadvisable, if we follow the prescribing information for the oral JAK inhibitors than in the majority of patients their use will be in patients with an inadequate response to dupilumab,” King said. “Of course, we are not robots, and we need to use our better judgment when considering treatment for any particular patient. But I think the prescribing information will prevail in the majority of cases.”

While dupilumab failure is not common in patients with atopic dermatitis, King noted that many patients still need better disease control than what they are getting from the biologic. As such, he considered JAK inhibitors to be “hugely important” in managing skin diseases such as atopic dermatitis.

“Dupilumab revolutionized AD, and so we sort of almost this kind of blind allegiance to it now, and we insist that our patients are doing well, but not everybody does,” he noted. “And now that we have abrocitinib and upadacitinib, the patients who do not have adequate disease control have treatment options. Just as dupilumab was revolutionary to AD, so will be the JAK inhibitors.”

For patients who do not respond to dupilumab, King conducts assessments including the Investigators Global Assessment (IGA), and the pruritis numerical rating scale to determine the severity of their disease and how they might benefit from certain JAK therapies.

He added that reasons for treatment failure are often much more nuanced than would be expected. As such, he recommended that providers utilize these tools to determine an adequate treatment option.

“Using these simple tools, the VIGA, the BSA dermatitis and pruritis NRS, I think that we can begin to sort out adequate response to treatment,” King said. “Of course, the patient's input is going to be critical in the determination of adequate control as well, and ultimately, I just think that with more and more treatments to offer patients, we will strive more and more for near complete remission of both dermatitis and pruritis, that should be our goal.”

Dr. Brett King returns to discuss the impact of JAK inhibitors in the management of atopic dermatitis.

How JAK Inhibitors Revolutionized Dermatology Care

In recent years, the conversations regarding coding guidelines from the Centers for Medicare and Medicaid Services (CMS) have been complex and occasionally frustrating.

Significant changes to evaluation and management codes (E/M) were made in the beginning of 2021, along with the first major overhaul in the Current Procedural Terminology (CPT) code in 25 years, prompting further discussion among providers regarding billing documentation.

In this episode of Derm Discussions, Brent Moody, MD, Nashville Dermatology Society, and the American College of Mohs Surgery, spoke to Dr. Brad Glick of the changes made to the E/M codes, as well as the long-term effects on billing.

“There's increased value for the E/M services, and that was done as a desire to reward cognitive work, not just in dermatology, but across all specialties,” Moody said. “It also made it a little bit easier, particularly for dermatologists to bill at higher levels, because the old paradigm of counting bullets…that went away, and it really boils down to medical decision making. So for some instances, it is easier to build at higher levels. Although as we learned at some areas, it's harder.”

He added that in some instances such as a full skin check, it is more difficult for providers to bill at a higher level due to changes made in the E/M codes, prompting Moody to suggest better guidance for providers on how to properly code for common clinical scenarios, in addition to consistency across different carriers.

“We can have different rules for every different insurance company, it's too confusing,” Moody said. “And CPT and CMS, they're the gold standard, we should all follow that one standard. So, it is a problem when carriers start to deviate from what CMS wants to do.”

To hear more from Dr. Moody, listen to the latest episode of Derm Discussions above.

Dr. Moody speaks to how these E/M code changes affect billing documentation and patient care.

Brent Moody, MD: The Implications of E/M Code Changes for Dermatology Care

Vitiligo, much like other inflammatory skin disorders such as alopecia areata and atopic dermatitis, is a complex condition with various physical and psychological burdens, affecting 1% to 2% of the global population.

For roughly 15 years, John E. Harris, MD, PhD, Professor and Chair, Department of Dermatology, Founding Director, Vitiligo Clinic and Research Center, has been intensely studying the pathogenesis of vitiligo, as well as potential treatments.

Harris initially studied type 1 diabetes when he was a student, but an encounter with a patient with vitiligo inspired him to become a dermatologist. In time, he became one of the most prominent vitiligo experts, whose skills are used daily at the University of Massachusetts Medical School (UMMS) in Worcester, MA.

In this interview with Dr. Brad Glick, Harris provided insight into his decades of research on inflammatory skin disorder including vitiligo and alopecia areata. He also offered an in-depth analysis on the most recent data surrounding the conditions, and promising new therapies involving topical steroids, JAK inhibitors and more.

In this episode of Derm Discussions, vitiligo expert John Harris, MD, PhD, discusses new tactics and therapeutic options in treating inflammatory skin disorders like vitiligo, alopecia areata, and atopic dermatitis.

John E. Harris, MD, PhD: The Current State of Vitiligo and Alopecia Areata Research

While these small molecule drugs have seen approvals in other domains—such as tofacitinib (Xeljanz) and upadacitinib (Rinvoq) for rheumatoid arthritis and ulcerative colitis—they have yet to make full headway into the dermatology space.

As of now, no drug has been approved for any single dermatologic condition. Currently, the US Food and Drug Administration (FDA) are reviewing applications for a variety JAK inhibitors—namely baricitinib, abrocitinib, upadacitinib, and ruxolitinib cream for the treatment of atopic dermatitis—but the agency has

While safety concerns should not be overlooked or taken lightly, the drug class has demonstrated promising efficacy in patients suffering from dermatologic conditions, including atopic dermatitis, psoriasis, alopecia areata, and vitiligo.

Even more, the safety profile of JAK inhibitors must be understood in the context of previous dermatology- and non-dermatology-related clinical trials—a fact that Brett King, MD, PhD, Associate Professor of Dermatology at Yale School of Medicine, stressed in this episode of 

King explained how JAK inhibitors work, emphasizing their potential place inside a dermatologist’s treatment arsenal.

He compared JAKs with biologic agents, like dupilumab, and speculated on the implications the addition of a drug class would have on diagnostic and prescribing strategies, particularly for atopic dermatitis. 

Both Glick and King expressed forward-looking, optimistic sentiments for the future while remaining grounded in the available evidence for a drug class that has the potential to revolutionize dermatologic care.

On the latest Derm Discussions, Brett King, MD, PhD, joins Brad Glick, DO, to discuss the potential of the JAK inhibitor class for dermatology. 

Brett King, MD, PhD: The Promise of Janus Kinase Inhibitors

Climate change is an issue of public health concern that has and will continue to have far-reaching consequences. Human activities and emissions have led to the buildup of carbon dioxide in the atmosphere and, as a result, a marked elevation in global temperatures.

Over time, these increased temperatures will lead to transformations of climates across the world, thus disrupting ecosystems and potentially affecting individual and societal quality of life. Therefore, the urgency of the situation falls on everyone, particularly healthcare providers—regardless of specialty.

 Misha Rosenbach, MD, of the Perelman School of Medicine at the University of Pennsylvania, noted, the climate change discussion is relevant for the field of dermatology. In fact, the dermatologic health of patients may be directly and indirectly impacted by these issues in question.

 Brad Glick, DO, spoke with Rosenbach about the speciality's relationship to the overall global health.

“There are a number of places you can point to and say, ‘does this directly affect dermatologists?’ if it’s things around the globe,” said Rosenbach. “We see with COVID that we’re all citizens of the same planet, and this is the only planet.”

They highlighted the urgency of having this discussion, the role of the dermatologist in this larger conversation, and how patient care and experiences may be impacted by climate change.

Rosenbach talked about collective and individual mitigation strategies aimed at reducing humanity’s overall carbon footprint.

Misha Rosenbach, MD, discusses how rising temperatures and climate change, issues of public health concern, are relevant to the field of dermatology. 

Intersections Between Climate Change and Dermatology

 Brad Glick, DO, brought on cosmetic dermatologist Valerie Callender, MD, to discuss practices in cosmetic dermatology. The conversation centered on Callender’s practice, the challenges faced during the COVID-19 pandemic, and the most frequent procedures performed over these past months.

For this episode, Glick continues this robust discussion on trends and technologies in cosmetic dermatology—this time gauging the experiences and perspective of board-certified dermatologist Rebecca Kazin, MD, Director of Clinical Research of Icon Dermatology and Aesthetics. 

Kazin, an experienced injector and trainer, detailed her own cosmetic practices, breaking down the procedures that are most common for her. She spoke in great length on the use of dermal fillers, including differences in injectables, best application practices, and ways to ensure optimal patient satisfaction.

Glick and Kazin also touched on approaches to related procedures, such as skin tightening, cryolipolysis, and micro-needling, thus highlighting the nuances in care, which methods are most effective, and how to navigate the patient-doctor dialgoue. 

The conversation spotlighted a hair product that Kazin developed with the intention of offering an over-the-counter hydrocortisone washout for dry scalp and related conditions. She offered some thoughts on its cosmetic and dermatologic potential and described its journey from inception to marketing.

on iTunes and Spotify to stay up-to-date on all the latest discussions with Brad Glick, DO.

Rebecca Kazin, MD, offers some insight into her cosmetic dermatology practices, including a new hair product that she developed.

Rebecca Kazin, MD: Cosmetic Dermatology Trends, Technologies, and Practices

 pandemic has forced changes and adaptations within 

. At the surface level, physicians have had to shift to telemedicine and determine which areas within their own practice continue to be viable.

Patients have faced postponement or cancellations (voluntary or not) of consultations and procedures.

In spite of this reality, dermatological care—and the healthcare industry at large—has continued serving and meeting patient needs to the best of their ability.

Furthermore, with a nationwide and global vaccination campaign fully underway, procedures and care practices that have been placed on halt are likely to resume for many clinicians.

Of course, this is a story well-known and often told. 

And yet, how might this past year have looked for a cosmetic dermatologist?

Brad Glick, DO, FAAD, sought this perspective in the latest episode of 

He sat down with Valerie Callender, MD, an internationally recognized dermatologist based in Genn Dale, Maryland, to talk with her about the challenges and shifts within her practice over this past year.

Callender discussed how dermatology and her practice have fared in light of these health measures, which procedures have been most affected by them, and what the outlook is for the future.

She also gave insight into her care practices and strategies, with particular consideration for the needs and expectations of patients of color.

Valerie Callender, MD, draws on her experiences in clinical practice to discuss cosmetic dermatology care practices and the challenges of this past year. 

Valerie Callender, MD: What's New in Cosmetic Dermatology

A new year means assessing how far the field of 

 has come in terms of its therapeutic options and offerings.

Recent years have seen new and emerging therapies for a variety of conditions. For example, the FDA has approved dupilumab—a biologic—for use in atopic dermatitis. Research has also suggested great potential for JAK inhibitors—such as ritlecitinib for vitiligo, abrocitinib for atopic dermatitis, and deucravacitinib for psoriasis.

s, Brad Glick, DO, talked with Todd Schlesinger, MD, Dermatology & Laser Center of Charleston, SC, about the newest therapeutic agents within the dermatologist toolbox.

Schlesinger is a board-certified dermatology and dermasurgeon who has committed himself to various types of research and development. His experience also extends to inflammatory dermatoses as well as new technologies, especially as they relate to laser and light-based therapies.

For this episode, he offered strategies on practical ways to manage dermatological diseases, pointing to the current and supporting literature and research. He covered various therapeutic classes—from biologics to the novel JAK inhibitors—for conditions such as atopic dermatitis, melanoma, plaque psoriasis, and alopecia areata.

Schlesinger spoke on new and ongoing research, which promises further advancements in the field, and agents that should be on every dermatologists’ radar.

As this derm discussion proves, there is certainly plenty of ground to cover in the realm of dermatology-related therapies.

Articles

Todd Schlesinger, MD, talks new therapies on the horizon and those that have already proven efficacious. 

Todd Schlesinger, MD: Surveying the Dermatological Treatment Landscape

How should a dermatologist treat itch? The answer certainly is not a straightforward one.

One thing is for sure. The underlying causes behind itch—or pruritis—are numerous. A dermatological condition like 

 can produce symptoms that may lead to irritation. Stress or anxiety may be the culprit. Or perhaps it could be a nerve disorder. Sometimes the cause may not be so obvious.

Identifying the cause is essential to prescribing the proper treatment. However, the appropriate therapy may not always be successful, and that can be a source of frustration for both dermatologist and patient.

After all, severe itch may significantly impact quality of life, especially if the sensation becomes debilitating.

In this episode of Derm Discussions, Peter Lio, MD, Clinical Assistant Professor of Dermatology & Pediatrics, Northwestern University Feinberg School of Medicine, spoke with Brad Glick, DO, FAAD, about the various causes leading to itch. He offered some insight into treatment options for patients suffering from such a challenging-to-treat sensation or symptom.

Lio also discussed some of the typical therapies that may be used to address acute and chronic itch, but he also touched on the potential of some alternative therapeutic options—such as acupuncture, cannabinoids, and hypnosis.

In this episode of Derm Discussions, Peter Lio, MD, discusses the difficulties treating itch as well as alternative—and perhaps surprising—therapeutic options. 

Peter Lio, MD: New and Emerging Therapies for the Management of Itch 

 certainly does not fall short in its breadth and depth of topics.

It goes without saying that many of the conditions faced by adults can impact children just the same. A pediatric dermatologist may have to deal with conditions like atopic dermatitis, molluscum and warts, tinea capitis, psoriasis, and hemangiomas, among others.

Of course, each issue presents its own set of challenges and may require unique approaches to treatment and management.

 host Brad Glick, DO, FAAD, Assistant Clinical Professor of Dermatology, Herbert Wertheim College of Medicine, talked with Lisa Swanson, MD, a board-certified pediatric dermatologist, about a variety of dermatological conditions that are common—and not-so-common—in pediatric patients.

Drawing directly from her clinical experience, Swanson provided insight into treatment strategies for a range of conditions—such as atopic dermatitis, psoriasis, and acne. She also talked about new and exciting therapies within the field of dermatology, many of which have indications extended to young patients.

“Getting the approval down to 4 or 6 or wherever it might be not only makes it easier for pediatric dermatologists to treat these kids, but I think it gives everybody a better comfort level with the medicines,” she said.

Swanson covered vast terrain in discussing the promising future of pediatric dermatology and the challenges that still remain.

Lisa Swanson, MD, and Brad Glick, DO, FAAD, discuss a wide range of dermatological conditions faced by pediatric patients—from acne to atopic dermatitis, and everything in between.

Lisa Swanson, MD: Unlocking the Pediatric Dermatology Toolbox

Dermatologist and professor Brad Glick, DO, FAAD, leads a monthly conversation with a fellow expert on the trends, news, and musings from the medical field of dermatology.

Derm Discussions