Tea with Dr D: Solving The Puzzle of Hidradenitis Suppurativa: Pulling All the Pieces Together for Each Patient
In this premiere episode of Tea with Dr D, Dr James Q Del Rosso welcomes Dr Lauren Lam, a Canadian dermatologist with special interest and strong experience in managing patients affected by hidradenitis suppurativa (HS). They engage in a thoughtful and comprehensive conversation about diagnosing and treating this common yet often elusive skin condition—especially in its early stages—which has been notoriously difficult to treat. Their discussion integrates both medical and surgical approaches to optimize outcomes.
Dr Lam shares how she built an efficient, trust-centered model of care at her Calgary clinic, from using intake tools and patient education videos to identifying comorbidities and staging severity. She walks through her approach to treatment selection—focusing on what brings the most value in that moment—and discusses when and how she incorporates patient education, intralesional corticosteroids, biologic therapy, deroofing, laser hair removal, and other approaches into her care strategy.
Whether you see HS regularly or only occasionally, this conversation offers practical strategies, clinical nuances, and a fresh perspective on improving care for this complex condition.
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25:46
Mailbag 1: Your Questions Answered
In this first mailbag edition of Derms and Conditions, Dr James Q. Del Rosso flies solo to answer your questions—submitted by clinicians across the country. From potassium monitoring to topical field therapy, it’s a rapid-fire round of guidance grounded in the latest literature, clinical experience, and practical wisdom.
Dr Del Rosso kicks things off with the ever-popular question: Do I really need to monitor blood potassium in healthy patients on spironolactone for acne? He breaks down current guideline perspectives, red flags for high-risk populations, and his own reasoning for when and why he orders labs.
Next, he walks through the expanding world of topical nonsteroidal agents for atopic dermatitis, including:
Ruxolitinib 1.5% cream (Opzelura) – FDA-approved for mild to moderate AD in patients ≥12 years old and also for vitiligo; Dr Del Rosso discusses addresses black box warnings, despite low systemic absorption in most real-world scenarios.
Roflumilast 0.15% cream (Zoryve) – Approved down to 6 years of age, well-tolerated with itch reduction data to back it.
Tapinarof 1% cream (VTAMA) – Approved down to 2 years of age and used effectively in moderate-to-severe disease with favorable skin tolerability.
He explains why these newer agents may be preferred over topical corticosteroids for sensitive areas like the face. In response to questions about actinic keratoses, Dr Del Rosso dives into tirbanibulin 1% ointment (Klisyri), a microtubule inhibitor used once daily for five days. While FDA-approved for face and scalp field treatment up to 100 cm², he shares how he’s successfully using it off-label for forearms and hands, sometimes in combination with cryotherapy.
The episode closes with a discussion of oral antibiotic safety in acne, including:
Why TMP-SMX (trimethoprim-sulfamethoxazole) works—but must be used selectively due to rare but serious adverse events (TEN, pulmonary toxicity)
Why azithromycin is not optimal for acne and only used selectively.
And why mandatory lab monitoring for oral tetracyclines like doxycycline or minocycline isn’t recommended routinely—but clinical vigilance is.
With insights on everything from lab work to lid margins, this is one episode you’ll want to bookmark, replay, and pass along to your dermatology colleagues.
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26:34
Wrapping Our HANDS Around Managing Chronic Hand Eczema
In this episode of Derms and Conditions, host Dr James Del Rosso speaks with Dr Linda Stein Gold, Director of Dermatology at Henry Ford Health, to unpack one of dermatology’s most frustrating and multifactorial conditions: chronic hand eczema.
They explore why chronic hand eczema isn’t a single disease but a spectrum of overlapping etiologies—ranging from atopic dermatitis and irritant or allergic contact dermatitis to more elusive triggers. Dr Stein Gold shares practical strategies for teasing out potential causes, discusses some potential limitations of patch testing, and highlights the importance of patient history and thorough skin assessment.
The conversation also covers current treatment approaches, from topical corticosteroids to systemic therapies, and introduces delgocitinib cream, a pan-JAK inhibitor under FDA review, as a unique and valuable nonsteroidal option. Drs Stein Gold and Del Rosso explain how its broad immunomodulatory action may help address the condition’s diverse inflammatory pathways while remaining well tolerated, even on fissured skin.
Whether you're managing stubborn cases or looking for updates on investigational therapies, this episode offers practice-ready recommendations for clinicians and a reminder not to overlook the emotional toll of hand eczema on patients’ daily lives.
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25:18
Oral Therapy for Psoriasis: Valuable Insights from April in April!
In this episode of Derms and Conditions, Dr James Q Del Rosso is joined by Dr April Armstrong, Chair of Dermatology at UCLA, for a thorough discussion of oral therapies for plaque psoriasis—what’s new, what still works, and how to choose the right treatment for the right patient.
They kick off with a practical discussion on older systemic options like methotrexate and
cyclosporine, including when these tried-and-true agents still have a place in modern practice.
From there, Dr Armstrong walks through the evolving role of apremilast, particularly in hard-to-
treat variants like palmoplantar pustulosis and in patients with milder disease who prefer oral
options. The pair then take listeners through the clinical data behind deucravacitinib, a selective
TYK2 inhibitor, highlighting its strong efficacy, minimal lab monitoring, and newly released five-
year safety results.
The conversation also covers real-world patient selection, payer considerations, and how
clinicians can use guidelines to support access to newer therapies. Whether you’re looking to
refine your psoriasis treatment strategy or better counsel patients on long-term safety, this
episode delivers practical pearls you can use in clinic tomorrow.
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22:09
Whom Do You Trust? Learn More About Trusts & Wills
In this episode of Derms and Conditions, Dr James Q. Del Rosso shifts gears from clinical
dermatology to something equally important but rarely discussed—legal and financial planning.
He’s joined by his longtime friend and dermatopathologist, Dr Clay Cockerell, who also happens
to be a licensed attorney with a passion for educating physicians about estate planning.
Dr Cockerell breaks down the fundamentals of trusts, wills, and malpractice insurance in plain
language, highlighting why every physician should care about these topics. Listeners will learn
the key differences between revocable and irrevocable trusts, how to protect assets from
creditors, and why picking the right trustee is critical.
They also dive into the historical roots of trusts (spoiler: think the Crusades), fiduciary responsibilities, and how physicians can control the distribution of assets during and after their lifetimes.
The conversation also covers non-compete clauses, contract negotiations, and the importance
of tail coverage in malpractice policies. Dr Cockerell shares real-world advice from his own
experience and emphasizes why physicians—especially new grads—should never sign contracts without legal review.
Packed with practical insights, humor, and a few personal anecdotes, this episode offers a
must-hear legal primer for dermatology professionals at any career stage.
Hear from the leading dermatologists and experts as they discuss the hottest topics in dermatology. Tune in for clinical practice tips and treatment pearls you can implement quickly and efficiently into your busy practices!
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