Introduction

Last month we wrapped up MedscapeLive! Hawaiian Dermatology Seminar. The conference was a packed 6 days, with 15 sessions, bonus presentations, CME symposia, receptions, hands-on workshops, and multiple fantastic collaborative panels. Dr. Linda Stein Gold, who co-chairs Hawaii Derm, shared, “With so many new drugs recently approved, it is great to hear all of the critical safety and efficacy information from those who have actual firsthand knowledge.” Highlighting one of the seminar’s biggest selling points, she added: “I appreciate having all of the lectures in one place so that I don't have to choose between topics. I can hear everything!”

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Faculty Pearls from Hawaii Derm

Rosacea round-up:

Patients don’t fit into a single subtype. Don’t even try to subtype them. Instead identify every feature of rosacea that is present and treat accordingly. Remember that our rosacea drugs are specialized. Agents for redness may not help with papules and vice versa. Most patients with rosacea will benefit from combinations of treatments and treatment modalities. - Julie Harper

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Updates in Vitiligo:

Vitiligo has tremendous psychosocial effects on our patients, but they greatly vary across patients. Assess the well-being of your patients and then learn to manage expectations. All treatments take time but make sure patients are stable before initiating therapy by assessing for signs of instability and leukotrichia. Then pick the appropriate topical, phototherapy, systemic, or surgical option. For non-segmental vitiligo, maintain treatment at a reduced frequency to prevent recurrence. Watch for new treatments for vitiligo. They are coming. I am honored to be part of this meeting and look forward to it every year. - Dr. Hamzavi

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Best Practices in Managing Actinic Keratosis:

The approach to treating AKs by both dermatologists and patients is full of complaints and obstacles…Coverage is always an excuse with the response “We can treat these when you meet your deductible…” as a copout, even though patients with AKs are no longer just Medicare age,” he explained. “Dermatologists complain that combination therapies are never promoted by pharma, and neither are the strategies to managing reactions…as a result compliance is marginal. Yet the reality is generic drugs don’t have coupon cards or samples, which is irrelevant when dermatologists are fixated on reactions and not outcomes. “Just freeze and go” has unfortunately led to the bandage phenomenon of treating AKs rather than approaching the big picture of the disease of photodamage and AKs that lead to skin cancer. Just like “pre-boarding” a plane is still boarding, and “pre-diabetes” is a warning sign, dermatologists need to consider AKs more than just “pre-cancerous” because the appearance of one usually means that 10 more are on the way and skin cancer prevention needs to be a priority.  Incorporation of topical therapies, photodynamic therapy, and other chemoprevention strategies need to be part of the routine no matter which climate or age group the patients are in. - Dr. Neal Bhatia