The Derm Resident: Boards Fodder and Clinical Pearls for Dermatology Residents

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Alopecia Boot Camp: Scarring vs Non-Scarring, Key Patterns, Dermoscopy Pearls, and First-Line Management | The Derm Resident
Contact: thedermresident.pod@gmail.com

Hosts Dr. Jonny Hatch and Dr. Deven Curtis present an “alopecia boot camp” framework focused on first distinguishing scarring (cicatricial) from non-scarring alopecia by assessing follicular ostia with dermoscopy, emphasizing that scarring implies permanent loss and requires urgent treatment at the active edge for biopsy and intralesional therapy. They review non-scarring causes including androgenetic alopecia (DHT-driven miniaturization, anisotrichosis; Hamilton-Norwood/Ludwig scales; minoxidil, finasteride/dutasteride, spironolactone in women, PRP and transplant with donor dominance), alopecia areata (CD8 attack, exclamation point hairs, yellow/black dots; ILK and FDA-approved JAK inhibitors baricitinib and ritlecitinib; totalis/universalis/ophiasis), telogen effluvium (delayed shedding after stressors; hair pull test; consider TSH and iron studies/ferritin), traction alopecia (fringe sign; may become scarring), and trichotillomania (broken hairs of varying length). Scarring alopecias covered include LPP/FFA (perifollicular erythema and tubular scale; hydroxychloroquine/doxycycline and steroids), CCCA (central centrifugal pattern; biopsy active border; discuss styling factors and PADI3), and rapid-fire pearls for DLE (follicular plugging), folliculitis decalvans (tufting; clindamycin/rifampin), dissecting cellulitis (boggy nodules/sinus tracts; follicular occlusion tetrad), and acne keloidalis nuchae (posterior scalp/neck plaques; consider laser/excision).

00:00 Alopecia Boot Camp
00:52 Why Hair Loss Is Hard
01:24 Scarring Versus Nonscarring
03:28 Follicular Ostia Clues
05:38 Androgenetic Alopecia Basics
08:05 Treating Pattern Hair Loss
08:34 Minoxidil ICU Story
12:08 Counseling and Transplants
13:44 Alopecia Areata Recognition
17:04 Areata Workup and Treatment
18:30 Telogen Effluvium Shift
20:31 Postpartum Shedding Explained
20:54 Hair Pull Test Basics
21:50 When to Order Labs
23:37 Traction Alopecia Red Flags
26:21 Trichotillomania Patterns
27:42 LPP and FFA Scarring Clues
30:09 Treating LPP and FFA Early
31:33 CCCA Diagnosis and Biopsy
36:04 Rapid Fire Scarring Alopecias
40:19 Clinic Safety Takeaways
41:12 Boot Camp Wrap Up
This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Hidradenitis Suppurativa (HS) Boot Camp: Diagnosis, Hurley Staging, Treatment Ladder & Surgical Options | The Derm Resident
Contact: thedermresident.pod@gmail.com

Dr. Jonny Hatch and Dr. Deven Curtis deliver a clinic-focused boot camp on hidradenitis suppurativa (HS), noting the misnomer (not a sweat-gland disease) and reviewing typical intertriginous involvement with painful nodules/abscesses and the pathognomonic double-ended open comedone. They discuss delayed diagnosis, stigma, family history, modifiable factors (smoking and obesity), and flare triggers (menses, friction, sweating, heat, diet). Hurley staging is outlined (I boils only; II recurrent abscesses with sinus tracts/scars; III diffuse interconnected tracts) with emphasis that severity and inflammation may not perfectly match stage. They highlight disease burden (pain, depression screening; associations with Crohn disease, PCOS, metabolic syndrome), exam pearls, and a treatment ladder: topicals (clindamycin with BPO), oral antibiotics (doxycycline, clinda/rifampin; rescue options), hormonal therapy, biologics (adalimumab, infliximab, IL-17 agents), and procedures (I&D, punch deroofing, deroofing, wide excision, reconstruction), plus counseling that HS is chronic, not due to hygiene, and requires ongoing support.

00:00 HS Boot Camp Intro
00:30 Name Origins and Misnomer
02:06 Classic Presentation and Diagnosis
05:04 Risk Factors and Flare Triggers
07:09 Hurley Staging Basics
11:12 Disease Burden and Comorbidities
13:13 Topicals and Lifestyle First Line
15:20 Oral Antibiotics and Escalation
16:58 Hormonal Therapy Pearls
20:00 Biologics for Moderate Severe HS
24:20 Surgical Options and Deroofing
29:38 Patient Counseling and Wrap Up
This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Psoriasis Part 2: Differentials, Psoriatic Arthritis Screening, and the Psoriasis Treatment Ladder | The Derm Resident
Contact: thedermresident.pod@gmail.com

Hosts Dr. Jonny Hatch and Dr. Deven Curtis continue psoriasis with a focus on chronic plaque differentials, psoriatic arthritis, and a practical treatment ladder. They review mimickers including seborrheic dermatitis and lichen simplex chronicus (including “sebo-psoriasis”), mycosis fungoides prompting biopsy when plaques are treatment-resistant or atrophic, hypertrophic lichen planus on shins, and guttate-pattern differentials such as pityriasis rosea, pityriasis lichenoides chronica, and secondary syphilis. They emphasize screening for psoriatic arthritis (about one-third of patients; HLA-B27 association) using joint/back pain history, nail findings, and dactylitis, with rheumatology referral when appropriate. Treatments covered include topical steroids by site, calcipotriene, tazarotene, roflumilast foam, tapinarof, phototherapy (narrowband UVB preferred over PUVA), and systemic therapies (methotrexate with folate, cyclosporine, apremilast, acitretin) plus biologics (TNF, IL-17, IL-23, ustekinumab) and deucravacitinib, along with biologic prescreening (TB, hepatitis, CBC/CMP, vaccine counseling) and psoriasis comorbidity risks.

00:00 Show Intro and Disclaimer
00:29 Plaque Psoriasis Differentials
02:21 Guttate Mimickers
03:25 Screening for Psoriatic Arthritis
04:53 Topical Treatment Basics
06:32 Nonsteroid Topicals and New Agents
08:13 Phototherapy UVB and PUVA
10:45 Systemics Methotrexate Deep Dive
13:45 Cyclosporine and Oral Options
18:11 Biologics TNF Alpha Inhibitors
22:41 IL-17 Inhibitors Key Pearls
25:47 IL-23 and IL-12/23 Therapies
28:23 Deucravacitinib and Biologic Workup
30:46 Psoriasis as Systemic Disease
31:32 Closing Pearls and Wrap Up
This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Psoriasis High-Yield Review (Part 1): Epidemiology, Immunopathogenesis, Triggers, and Clinical Variants | The Derm Resident

Hosts Dr. Jonny Hatch and Dr. Deven Curtis review psoriasis for residents, covering historical confusion with leprosy, prevalence (about 2% worldwide; higher in the US/Canada), bimodal onset (20–30 and 50–60), and systemic burden including psoriatic arthritis and comorbid metabolic, cardiovascular, and mood disease. They discuss genetics (notably HLA-Cw6 at PSORS1) and modern immunopathogenesis centered on the IL-23/Th17/IL-17 axis, including keratinocyte–immune “vicious cycle,” neutrophilic histology (Munro microabscesses, spongiform pustules of Kogoj), and TNF’s broad role. The episode reviews disease memory, Koebner phenomenon, triggers (strep, stress, HIV, hypocalcemia, pregnancy, key medications), lifestyle associations, classic plaque features and signs (Auspitz, Woronoff), PASI scoring, and variants including guttate, erythrodermic, and pustular psoriasis (IL36RN/DITRA; spesolimab), plus scalp, inverse, nail, and rare mucosal involvement. 
Contact: thedermresident.pod@gmail.com

00:00 Show Intro and Disclaimer
00:36 Psoriasis History Origins
02:06 Epidemiology and Onset
03:23 Systemic Burden Comorbidities
04:22 Genetics and HLA CW6
06:38 Modern Immune Model
08:43 Trigger to T Cell Cascade
12:02 Th17 Cytokines and Plaques
15:08 IL 23 Th17 Axis Explained
18:20 Histology Neutrophils and TNF
20:48 Disease Memory and Koebner
22:36 Triggers Infections Drugs Lifestyle
27:19 Plaque Psoriasis Clinical Exam
30:10 PASI Score Made Simple
32:37 Guttate and Erythrodermic Types
35:40 Pustular Variants and Genetics
40:11 Special Sites Nails Mucosa
42:14 Wrap Up and Part Two
This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.

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Chronic Pruritus Workup & Treatment Pearls (CPUO, Neuropathic Itch, Nemolizumab, JAKs) | The Derm Resident
Contact: thedermresident.pod@gmail.com
Dr. Jonny Hatch hosts Dr. Diego Da Silva, a chronic pruritus expert and host of Skin In the Game, to discuss a practical approach to itch. They outline an initial framework based on distribution (localized vs generalized), time course (with shorter duration and older age raising concern for malignancy), and morphology (primary lesions vs excoriations only). For localized itch without rash, they emphasize neuropathic etiologies (notalgia paresthetica, brachioradial pruritus, meralgia, dysesthesias), consider spine wear-and-tear, and discuss PT plus gabapentinoids and other neuromodulators. For generalized pruritus without rash, they review ROS for constitutional symptoms, recommend considering biopsy of “normal” itchy skin (e.g., CTCL, sarcoid), and suggest labs (CBC, CMP, TSH, A1C, SPEP/IFE, ferritin, vitamin D), chest X-ray, and BP testing/DIF. Treatment pearls include skincare, phototherapy, atopic-directed therapies (dupilumab, nemolizumab), JAK inhibitor counseling (noting shingles risk and “JAKne”), and empiric ivermectin for possible scabies; off-label options include low-dose naltrexone, dronabinol, and intranasal butorphanol, plus advice for residents to develop a niche and “declare” expertise.

00:00 Show Introduction
00:59 Why Itch Matters
01:26 Finding a Niche
04:44 First Steps in Pruritus
07:00 Localized Itch Workup
09:02 Neuropathic Itch Treatments
11:32 Generalized Itch Workup
14:32 Labs Imaging and Biopsy
17:54 Treating CPUO Like Atopy
21:49 Choosing First Biologic
22:27 Nemolizumab Itch Breakthrough
23:58 JAK Inhibitors Safety Reality
26:08 Managing Shingles And Jackne
28:05 Treating Jackne Options
28:54 Derms As Real Doctors
30:54 Low Dose Naltrexone Role
32:15 Scabies And Empiric Ivermectin
33:09 Off Label Itch Rescue Meds
35:42 Advice And Podcast Wrap Up
This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.