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AAD Annual Meeting Echoes continued from page 13

• Lasers: Fractional picosecond technology offers distinct Translating Evidence Into Practice: Acne Guidelines –
advantages. There is virtually no risk of PIH and overheating Isotretinoin Guidelines
side effects. It does take a number of treatments to accomplish Dr. Jonathan Weiss (Gwinnett Clinical Research Center, GA)
pigment removal.
• Picosecond laser: Fractional optics appear to result in better • Expand usage to moderate acne in appropriate patients
outcomes than with the flat optic. The photoacoustic effect - Treatment resistant
of the flat optic has a significant thermal component, which - Physically scarring
can sometimes cause melasma to flare. - Psychosocial distress
• Daily dosing: severe acne
Clinical Pearls In Autoimmune Connective Tissue Diseases - 0.5mg/kg QD for 1st month
Dr. Lisa Drage (Mayo Clinic Rochester) - 1mg/kg QD after 1st month
- Extremely severe acne: lower starting dose +/- steroids
• Dermatomyositis • Cumulative dosing: to reduce chance of relapse
- Pathologic pitfall: interface dermatitis is seen in both lupus - 120mg/kg minimum
and dermatomyositis - up to 150mg/kg – no widespread evidence that more helps
- Dermatomyositis is often misdiagnosed as cutaneous lupus • Low dose isotretinoin: moderate AV
erythematosus - 0.25 – 0.4mg/kg/day – better tolerated than higher doses,
- Dermatomyositis has LOTS of skin signs and a symptom of fewer side effects, higher patient satisfaction
ITCH! This will help to differentiate it from cutaneous lupus • Intermittent dosing NOT RECOMMENDED
- Important to diagnose and differentiate! Dermatomyositis • Isotretinoin is highly lipophilic, best absorbed with food.
is a skin sign of internal malignancy Advise patients to take it with meals.
• Subacute cutaneous lupus erythematosus • Mood NOT negatively affected in vast majority of individuals
- SCLE is not always annular, the psoriasiform variant is - More study needed, monitoring still necessary
common! • No proven link to Inflammatory Bowel Disease (IBD).
- Review medications in any case of lupus Current consensus evidence is insufficient to prove either
- Drug-induced SCLE is caused by some common drugs an association or causal relationship between isotretinoin
– proton pump inhibitors, antihypertensives, biologics, use and IBD.
antifungals, etc • Isotretinoin monitoring frequency
• Discoid lupus - Changes in CBC, LFTs and lipids did not meet criteria for
- 24% of DLE patients have musosal involvement high risk
- Oral findings are common in patients with lupus… look - Monthly monitoring NOT recommended
for them! • Monitor LFTs and lipids
- Oral discoid lupus are usually asymptomatic - Baseline
- Malignant transformation of oral lupus has been described - After 2 months of therapy
• Eosinophilic fasciitis - Monthly if abnormalities found/persist
- Abrupt onset of edema and progressive induration of • Delay elective procedures 6-12 months when possible.
the extremities, skin signs, peripheral eosinophilia, fascial Careful consideration on case-by-case basis for earlier
thickening on MRI and/or biopsy procedures OK
- Incisional biopsy including fascia is gold standard • Teratogenicity
- Early, aggressive treatment for an aggressive disease: - Patient-independent/long-acting contraceptives whenever
systemic steroids +/- methotrexate possible/appropriate

St. Luke’s Medical Center Department of Dermatology
POST-GRADUATE COURSE: DERMILLENNIUM - The IN in SKIN continued from page 15
more exciting and entertaining discourse with an up-to-date presentation of the A lively and fruitful day was coming to an
on the topics. different energy-based devices and skin end as Dr. Lia Nebrida-Idea, FPDS, Head
treatment modalities that have caught the of Postgraduate Course, was invited on
The final panel discussion for the day was attention and preference of millennial-age stage to give a brief closing message.
entitled Crazy Rich Asian Skin: How to Get dermatology patients. DERMILLENNIUM proved to be as electric
that Asian Glow, which showcased the and impactful as the millennial age it
expertise of three distinguished speakers As a fun fact, the audience was “shookt” to portrayed, where innovation and learning
– Drs. Aivee Aguilar-Teo, FPDS, Claudia learn that an allusion was made to Dr. Teo in is possible anywhere, at a heightened
Samonte, FPDS and Maria Suzanne the best-selling novel, Crazy Rich Asians by speed, at the tip of your fingers, at the click
Datuin, FPDS. They wowed the crowd author Kevin Kwan. of a button.
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