Outside the Box: The Power of Combining Art and Science

In this episode of Derms and Conditions, host James Q Del Rosso, DO, interviews Naiem Issa, MD, PhD, FAAD, a dermatologist and dermatologic surgeon practicing at Forefront Dermatology in Vienna, VA, to discuss innovative approaches to treating challenging conditions. From exploring groundbreaking treatments for vitiligo to the mechanisms behind systemic responses in inflammatory diseases, this episode offers valuable insights into the intersection of art and science in dermatology. The conversation begins with a focus on a novel combination treatment for a challenging disease state: vitiligo. Dr Issa explores the potential of combining topical ruxolitinib with microneedling to promote repigmentation. He explains the rationale behind this approach, citing the proinflammatory cytokine milieu induced by microneedling, which can promote melanogenesis and repigmentation. He shares a successful case study involving a pediatric patient with segmental vitiligo who, after failing multiple other therapies, achieved significant repigmentation after undergoing this combined treatment. The discussion then shifts to Dr Issa's experiences with observing responses in untreated areas of inflammatory disease after treating a specific area. They consider the possible mechanisms of action behind this phenomenon and discuss the case of pediatric patient with severe atopic dermatitis who saw improvement in untreated areas after applying tapinarof to symptomatic areas, suggesting a possibly systemic anti-inflammatory effect mediated by regulatory T cells. Their discussion concludes by addressing the critical unmet need in the supply chain for epinephrine and the impact on clinical practice where lidocaine with ephinephrine is necessary for local anesthetic use. They discuss midodrine, an alpha-1-specific agonist, as an alternative to epinephrine, with findings indicating that midodrine allows for the reduction of epinephrine needed in lidocaine combinations and the significant effects observed at lower dilutions. Tune in to the full episode to hear more about Dr Issa’s innovative approaches, groundbreaking research, and cutting-edge strategies that address critical needs in dermatology!