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Dermasphere Podcast

Dermasphere is a podcast by dermatologists, for dermatologists, that delivers the latest dermatology research direct to your ears.
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31/05/2026

Have you listened to our latest two episodes yet?

In Episode 183 we discussed:
➡How to have useful conversations with Danny Bobrow!
➡Beta-blockers for rosacea
➡PDL for NMSC prophylaxis

In 184, we discussed:
➡ Cutaneous findings in statin-induced necrotizing myopathy
➡ ACD to diabetes devices (Part 1)
➡ Trichophyton indotineae - use itraconazole!
➡ Eosinophilic pustular folliculitis in infants
➡ Green beans for diaper rash in the NICU
➡ Confocal in kids

26/05/2026

Now for Luke's Top 5 from Episode 182! 🎧

1️⃣Pulse dye lasers operate at 585-595 nm, a peak absorption range for oxyhemoglobin. A reasonable starting approach is ~7-10 mm spot size, ~1.5 ms pulse duration, and ~6-7 J/cm² fluence, though settings should be individualized.
2️⃣Larger PDL spot sizes at 15 mm (vs ≤10 mm) improve efficiency in treating port wine birthmarks. Retrospective data show ~50% clearance achieved in ~4-5 treatments with larger spots versus ~8-9 with smaller ones, with shorter sessions and less need for anesthesia in young children.
3️⃣Larger spot sizes improve depth of pe*******on and reduce light scattering, increasing effective energy delivery. Available data have not shown a significant increase in complications, though careful parameter selection remains important.
4️⃣Topical anesthetics should be used cautiously in infants

14/05/2026

And now for Dr. Tarbox's Top 5 from Episode 182! 🤓 Extra props for the Star Wars pun.

1️⃣Tranexamic acid (TXA) is an antifibrinolytic that inhibits plasmin formation by binding plasminogen. As a synthetic lysine analog, it blocks plasminogen activation and stabilizes fibrin, reducing bleeding.
2️⃣TXA also impacts melanogenesis by interfering with plasmin-mediated pathways. By reducing plasmin activity, it decreases UV- and hormone-driven melanocyte activation and tyrosinase activity, contributing to its role in melasma.
3️⃣Plasminogen binding occurs at lysine-binding sites known as “kringle domains.” This interaction is key to TXA’s mechanism in both hemostasis and downstream inflammatory signaling.
4️⃣Melasma involves complex paracrine signaling between keratinocytes, melanocytes, and vascular factors. TXA likely works in part by dampening this signaling cascade rather than acting directly on melanocytes alone.
5️⃣A meta-analysis evaluated TXA (topical or intralesional) for reducing Mohs-associated bleeding. TXA decreased intraoperative bleeding without increased postoperative or thromboembolic complications. It shows a strong safety profile, even in anticoagulated patients.

14/05/2026

Have you listened to Episode 182 yet? This was a good one. We were joined by Dr. Doug Grossman to discuss Melanoma prognostic gene expression profiles! We also discussed TXA in Mohs, and Large-spot PDL for port wine stains. What was your favorite part?

04/05/2026

Check Dr. Johnson & special guest Dr. Christopher’s Top 5 from Ep. 181!

Luke’s Top 5:
1️⃣ Asking about recurrent painful nodules in the axilla, groin, or abdominal folds lasting ≥6 months is highly suggestive of HS (≈90% sensitivity, 97% specificity).
2️⃣ Infantile acne is rare but resembles adolescent acne with comedones; topical clindamycin monotherapy can be used. Acne in ages 3–7 is uncommon—consider inhaled steroid exposure and endocrine evaluation.
3️⃣ In urticaria—especially in the southern US—consider alpha-gal syndrome (tick-associated red meat allergy) as a cause of chronic symptoms.
4️⃣ GLP-1 agonists have been linked to telogen effluvium, possibly affecting hair cycling and follicle health. Rapid weight loss may also cause skin laxity; counseling on adequate protein intake and resistance training may help.
5️⃣ Icotrokinra is now FDA approved for psoriasis. In a phase 3 RCT, PASI90 was achieved in ~50% at week 16 vs ~4% placebo, increasing to ~65% by week 24.

Dr. Christopher’s Top 5:
1️⃣ All melanocytic lesions should be evaluated with dermoscopy. Correlating dermoscopic (horizontal) and histologic (vertical) findings improves accuracy; discordance warrants further evaluation.
2️⃣ Switching between polarized and non-polarized dermoscopy reveals complementary structures; some features (e.g., gray/black pigmentation in lentigo maligna) are better seen in specific modes.
3️⃣ Helpful dermoscopy resources: Dermoscopy Happy Hour (YouTube), International Dermoscopy Society modules, and conferences like the American Dermoscopy Meeting and Mayo Dermoscopy Symposium.
4️⃣ The “plumage sign” (feather-like pattern) is described in pigmented SCC and appears highly consistent, even in macular, non-scaly lesions.
5️⃣ Multiple Aggregated Yellow-White (MAY) globules represent dystrophic calcifications in BCCs, more common in aggressive subtypes, and may guide management toward excision or Mohs rather than ED&C.

17/04/2026

Have you listened to Episode 181 yet? In this episode, we were joined by Dr. Michael Christopher for a Dermoscopy master class! 🔎
This episode discussed the following topics:
The plumage sign in dermoscopy: pigmented SCCis
Highlights from the AAD
Icotrokinra for psoriasis

What was something new that you learned? 🤓

16/04/2026

And now for Dr. Tarbox's Top 5 from Episode 180! 🎧 (Dr. T, we love it when you geek out!)

1. Short anagen hair syndrome involves a shortened anagen phase (4-6 months vs 2-6 years), often linked to WNT pathway mutations, resulting in hair that cannot grow long. It is benign and frequently improves with age.
2. Trichogram findings in short anagen syndrome include tapered hair shafts and increased telogen hairs, which helps distinguish it from hair breakage. Tapering indicates early shedding rather than external damage.
3. The hair cycle (anagen, catagen, telogen) underlies most pediatric hair disorders, with abnormalities in anagen duration driving conditions like short anagen syndrome. Understanding this helps differentiate growth disorders from true hair loss.
4. Loose anagen hair syndrome results from abnormal inner root sheath adhesion, causing poorly anchored hairs that are easily and painlessly extracted during the anagen phase. It commonly presents in young children with unruly, thin hair.
5. Schöpf-Schulz-Passarge syndrome is a rare autosomal recessive ectodermal dysplasia associated with WNT mutations, characterized by eyelid hidrocystomas, hypotrichosis, nail dystrophy, and hypodontia. Recognition is important for diagnosis and counseling.

16/04/2026

If you haven't listened to Ep. 180 yet, here are Dr. Johnson & special guest, Dr. Lam's, Top 5!🎧

Dr. Johnson's Top 5:
1. Updated NF1 diagnostic criteria distinguish mosaic from generalized disease; unilateral café-au-lait macules or freckling suggest mosaicism, which impacts prognosis, surveillance, and genetic counseling.
2. Café-au-lait macules (CALMs) are not specific to NF1 and can occur in conditions like constitutional mismatch repair deficiency (CMMRD) and Legius syndrome, so clinical context and associated features are key to avoiding misdiagnosis.
3. McCune-Albright syndrome presents with large, irregular CALMs and endocrine abnormalities such as precocious puberty. Skin findings often precede systemic disease, making early recognition important.
4. Short anagen syndrome causes persistently short hair due to a shortened growth phase, typically improving after puberty. It is benign but can be distressing; minoxidil may help in select cases.
5. Loose anagen hair syndrome results from defective hair anchoring, causing easily extractable, painless hairs with a “ruffled sock” appearance on microscopy. It often improves with age but may persist into adulthood.

Dr. Lam’s Top 5:
1. CALMs may be benign, but ≥6 lesions in a young child strongly suggest NF1 (prevalence ~1 in 3,000), and many patients meet full criteria over time.
2. CMMRD is a rare autosomal recessive cancer predisposition syndrome involving MLH1, MSH2, MSH6, or PMS2 mutations, presenting with CALMs and early malignancies, requiring prompt recognition and surveillance.
3. CALMs are associated with multiple syndromes (NF1, McCune-Albright, CMMRD, Legius), many involving the RAS/MAPK pathway; differentiation depends on systemic features and genetic testing.
4. Other RASopathies—such as Noonan syndrome with multiple lentigines, Costello syndrome, and cardiofaciocutaneous syndrome—may also present with CALMs plus cardiac and developmental abnormalities.
5. Revised NF1 criteria now emphasize a parent meeting diagnostic criteria (rather than any first-degree relative) to reduce misdiagnosis, especially distinguishing NF1 from overlapping syndromes like CMMRD.

07/04/2026

Have you listened to Episode 180 yet? We were once again joined by the awesome Dr. Joseph Lam! 🎧
Check out the topics we discussed below:
- Café-au-lait spots
- Short anagen syndrome
- Medicare drug price negotiation

This episode also featured a clip show from the past 10 episodes!

03/04/2026

Friends of the Show at AAD! (And a couple of Team Dermasphere members). We had such a blast at and loved getting to see everyone!

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