Derm-it Trotter! Don't Swear About Skincare.

Psoriasis can look like “just plaques,” but the biology underneath is a lot bigger and a lot more hopeful than most people realize. We sit down with Dr. Naiem Issa, a board-certified dermatologist and dermatologic surgeon involved in dermatology research and drug development, to unpack what psoriasis really is: a genetically primed inflammatory disease that shows up on the skin, but also signals from within. We talk practical triggers patients actually recognize, from emotional or surgical stress to infection and skin trauma, and why the Koebner phenomenon can make injured skin a new target.

We build a clear map of the immune pathway clinicians rely on when picking modern psoriasis treatments. We walk through the immune “funnel” from TNF to IL-23 and TYK2 signaling, and finally to IL-17, the key effector cytokine that helps drive rapid skin turnover, scaling, and inflammation. If you’ve ever wondered why your care team keeps mentioning cytokines, interleukins, or “biologics,” this is the plain-English framework that connects those terms to what you see in the mirror and how you feel day to day.

We also get specific about IL-17 inhibitors and why “same class” doesn’t mean “same drug.” Blocking IL-17A alone, blocking IL-17A plus IL-17F, or blocking the IL-17 receptor can lead to meaningful differences in speed of clearance, durability, and what happens if you pause treatment. We discuss pharmacokinetics, withdrawal-arm trial data, time to flare, and the reassuring concept of recapturing response after restarting. We close with how we think through safety first, comorbidities like inflammatory bowel disease, joint involvement and psoriatic arthritis, injection preferences, and shared decision making.

If you found this helpful, subscribe, share it with someone navigating psoriasis treatment options, and leave a review with the question you want us to tackle next.

DISCLAIMER: The views and opinions expressed in the Derm-it Trotter! podcast are those of the host and guests and do not necessarily reflect the views or positions of the guests’ or host’s institution or employers. The Derm-it Trotter! Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

Skincare rules feel totally different when pregnancy enters the chat, and the internet does not make it easier. We sit down with Dr. Kelly Tyler, a rare double board-certified expert in OB-GYN and dermatology, to give you a clear, evidence-based guide to pregnancy safe skincare that you can actually use at the bathroom sink. One of the biggest mindset shifts is simple: if you are trying to get pregnant, we recommend you start following pregnancy skincare guidelines now, because you can be several weeks pregnant before a home test turns positive. 

We break down what matters most for safety: topical vs oral exposure, how much skin you apply a product to, and why product “vehicles” like ointments can absorb more than gels or liquids. Then we get specific about acne treatment during pregnancy, including why topical retinoids like adapalene and tretinoin are best avoided, while ingredients such as azelaic acid, benzoyl peroxide, and salicylic acid are often reasonable options when used appropriately. For tougher cases, we talk through which oral antibiotics are commonly used in pregnancy and which medications to avoid, including tetracyclines and doxycycline. 

We also tackle melasma in pregnancy, the hydroquinone warning, and why sunscreen is still the best daily anti-aging and hyperpigmentation prevention tool. From bakuchiol and “natural” skincare claims to newer trends like peptides and exosomes, we share a practical rule: if the data is thin, it is okay to pause. Finally, we cover eczema and pregnancy, including how to use topical steroids conservatively and what we know about short courses of oral steroids for severe flares. 

If this helped you feel calmer and more confident about pregnancy safe skincare, subscribe, share this with a friend who is trying to conceive, and leave us a review so more people can find science-first guidance. What product are you most unsure about right now?

DISCLAIMER: The views and opinions expressed in the Derm-it Trotter! podcast are those of the host and guests and do not necessarily reflect the views or positions of the guests’ or host’s institution or employers. The Derm-it Trotter! Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

Medicare rules can feel distant until they change what happens in the exam room. Today we sit down with board-certified dermatologist and leading advocate Dr. Sandy Marchese Johnson to explain why a new CMS proposal has physicians calling it a “three-part bomb” and why patients should care right now.

We start with the uncomfortable math: Medicare physician reimbursement has effectively gone down over decades, even as inflation and practice expenses rise. Then we translate policy into real life. The proposed modifier 25 change could cut payment when we evaluate a problem and do a procedure on the same day, the exact kind of efficient, patient-friendly visit many people depend on. That can push clinics toward split appointments, more travel, more time off work, and delays for things like biopsies or treatment of multiple concerns in one visit.

We also dig into the overhead most patients never see: staffing ratios, supplies, rent, insurance, and the technology required to run a modern dermatology practice. Proposed changes to indirect expense calculations could hit in-office specialties especially hard and accelerate consolidation, shrinking access to independent private practices. Finally, we talk about who gets a voice in how medical services are valued, why clinician input matters, and what the CMS timeline looks like from public comment to potential January 1 implementation.

If you’ve ever wondered why call-backs take longer, why waitlists grow, or why clinics ask you to come back for something that used to happen the same day, this conversation connects the dots. Subscribe, share this with someone who relies on Medicare, and leave a review with your biggest question about how these rules should be written.
DISCLAIMER: The views and opinions expressed in the Derm-it Trotter! podcast are those of the host and guests and do not necessarily reflect the views or positions of the guests’ or host’s institution or employers. The Derm-it Trotter! Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

Hidradenitis Suppurativa (HS) can steal your comfort, your workouts, your sleep, and sometimes your confidence, all while getting dismissed as “just boils.” We wanted a clear, practical roadmap for hidradenitis suppurativa treatment, so we brought on Dr Graham Litchman, a board-certified dermatologist and clinical trials leader, to talk through what actually helps patients now and what’s coming next.

We start by translating the basics: what biologic medications are, why so many names end in “-mab,” and how to think about inflammation as a cascade you can block upstream or downstream. Then we get concrete about HS therapies, including the limitations of older staples like topical benzoyl peroxide, topical clindamycin, doxycycline, hormonal approaches, metformin, isotretinoin, and long-term steroids. From there, we dig into the three FDA-approved biologics for hidradenitis suppurativa, including adalimumab (Humira), secukinumab (Cosentyx), and bimekizumab (Bimzelix), plus why switching within the same drug class can still be a winning move.

We also tackle what patients worry about most: side effects, infection risk, and how we “qualify” someone for the right advanced therapeutic based on medical history like inflammatory bowel disease or malignancy. A huge theme is the HS “window of opportunity” and why early control may prevent progression, tunnels, and permanent scarring. We close with pediatric and adolescent HS considerations and a look at the future, including next-wave biologics and oral small-molecule JAK inhibitors like povorcitinib.

If you want more clarity and better questions to bring to your dermatologist, listen now, share this with someone dealing with HS, and subscribe and leave a review so more people can find real help.
DISCLAIMER: The views and opinions expressed in the Derm-it Trotter! podcast are those of the host and guests and do not necessarily reflect the views or positions of the guests’ or host’s institution or employers. The Derm-it Trotter! Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.