Latest / The Science of Skin / Pediatric Dermatology Guide: Eczema, Psoriasis, Alopecia, Acne & Hemangiomas

Transcript

Pediatric Dermatology Guide: Eczema, Psoriasis, Alopecia, Acne & Hemangiomas · The Science of Skin

• 0:08
  SPEAKER_01: Hello and welcome to the Science of Skin Podcast.
• 0:11
  SPEAKER_01: My name is Dr.
• 0:12
  SPEAKER_01: Ted Lane.
• 0:12
  SPEAKER_01: I am a board-certified dermatologist in Austin, Texas.
• 0:16
  SPEAKER_01: And I have a special treat for everyone today because I have a good friend and an amazing pediatric dermatologist, Dr.
• 0:24
  SPEAKER_01: Lisa Swanson from Boise, Idaho.
• 0:27
  SPEAKER_01: Hi, Lisa.
• 0:28
  SPEAKER_00: Hi, Ted.
• 0:29
  SPEAKER_00: I'm so excited to be here.
• 0:30
  SPEAKER_00: What an honor to be on your pod.
• 0:33
  SPEAKER_01: Oh my god.
• 0:33
  SPEAKER_01: And Lisa, you have your own pod.
• 0:35
  SPEAKER_01: I have been on your pod.
• 0:36
  SPEAKER_01: It was such an honor for me as well.
• 0:38
  SPEAKER_01: Remind everyone the name of your podcast, please.
• 0:41
  SPEAKER_00: Yes, my podcast is called Skin Credible, because your skin is incredible and it provides credible information about your skin.
• 0:48
  SPEAKER_00: And your episode was amazing.
• 0:50
  SPEAKER_00: We talked about skin care.
• 0:52
  SPEAKER_01: Yeah, yeah, we did.
• 0:53
  SPEAKER_01: So skin credible, everybody.
• 0:55
  SPEAKER_01: Um, listen, just let me get this out of the way, Lisa, real quick.
• 0:58
  SPEAKER_01: But for everyone listening, if during this episode you have questions or afterwards, if you have thoughts for new uh episode topics, please send us an email at questions at scienceofskinsummit.com.
• 1:12
  SPEAKER_01: That's questions at science of skinsummit.com.
• 1:15
  SPEAKER_01: And of course, if you're liking what you're hearing, please give us a five-star rating and subscribe.
• 1:20
  SPEAKER_01: The growth of this podcast comes by word of mouth, and we've been so excited to hear from so many people that they like what they're hearing.
• 1:28
  SPEAKER_01: So please let us know.
• 1:29
  SPEAKER_01: Um, but today we're talking about pediatric dermatology, because that's what Lisa Swanson is an expert in.
• 1:36
  SPEAKER_01: I'm sure you're no, that's not true.
• 1:38
  SPEAKER_01: She's actually an expert in many things.
• 1:40
  SPEAKER_01: Pediatric dermatology dermatology is just one of them.
• 1:44
  SPEAKER_01: But um, we were talking before, Lisa, that you and I share a love of reality TV.
• 1:50
  SPEAKER_00: Yes.
• 1:51
  SPEAKER_01: And you in particular love The Bachelor and The Bachelorette.
• 1:55
  SPEAKER_00: Yes.
• 1:56
  SPEAKER_00: The entire Bachelor franchise.
• 1:58
  SPEAKER_00: I'm a proud member, Bachelor Nation.
• 2:00
  SPEAKER_00: Love, love, love.
• 2:02
  SPEAKER_00: Celebrate everything.
• 2:03
  SPEAKER_00: The Bachelor, Golden Bachelor, All the Bachelorettes, Bachelor in Paradise.
• 2:08
  SPEAKER_00: I was I was super bummed that we didn't get a Bachelorette uh season this spring.
• 2:14
  SPEAKER_00: I don't know if you heard about that, Ted.
• 2:16
  SPEAKER_01: I did, Lisa.
• 2:18
  SPEAKER_01: I did.
• 2:18
  SPEAKER_00: It was a big deal.
• 2:19
  SPEAKER_01: It was a big deal because on my social media feed, I saw a video of a crazy woman throwing metal stools at her boyfriend who was filming it with her five-year-old right next next to him.
• 2:34
  SPEAKER_00: Yeah, the video did not portray it in the best light.
• 2:38
  SPEAKER_00: Um, that is for sure.
• 2:40
  SPEAKER_00: Yeah.
• 2:41
  SPEAKER_00: Do you do you know the story of Taylor Frankie Paul, Ted?
• 2:45
  unknown: No.
• 2:46
  SPEAKER_00: TFP?
• 2:47
  SPEAKER_00: No.
• 2:47
  SPEAKER_01: No, I don't think I do.
• 2:48
  SPEAKER_01: Oh, but oh yeah, yes, Secret Lives of Mormon Wives.
• 2:51
  SPEAKER_00: Yes, yes.
• 2:52
  SPEAKER_00: So Taylor Frankie Paul is an LDS woman in Salt Lake City, and she started Mom Talk, which was this TikTok group for moms in Salt Lake, and they would get together and do dances and stuff.
• 3:04
  SPEAKER_00: And then she admitted that there was a swinging scandal amongst the group.
• 3:10
  SPEAKER_00: And she admitted that on social media.
• 3:12
  SPEAKER_00: And then she was given a show called Secret Lives of Mormon Wives, and her and her husband divorced, and she has two kids from her first relationship, and then she met Dakota, and they have this chemistry, but it's like a dangerous chemistry, and they just keep having problems with each other, and some of those problems become violent.
• 3:30
  SPEAKER_00: And so Taylor Frankie Paul had been arrested for a domestic violence uh issue in 2022, 2023, and then her and Dakota have this on and off relationship, this tumultuous relationship, and then they finally decide to end it.
• 3:47
  SPEAKER_00: And then uh ABC says, You know what you need, Taylor Frankie Paul.
• 3:53
  SPEAKER_00: After you've had she needs a last name.
• 3:56
  SPEAKER_00: Yeah.
• 3:57
  SPEAKER_00: Paul was her last name.
• 3:58
  SPEAKER_01: Oh, okay.
• 3:59
  unknown: Yeah.
• 4:01
  SPEAKER_00: So she had, you know, the swinging scandal, divorce, two kids, Dakota, domestic violence.
• 4:07
  SPEAKER_00: She had a baby with Dakota, and they said, You know what you need is you need to be our next bachelorette.
• 4:13
  SPEAKER_00: And so they had her film her entire season.
• 4:15
  SPEAKER_00: The entire season was filmed, Ted.
• 4:18
  SPEAKER_00: And then three days, three days before it was supposed to drop, video of that domestic violence thing surfaced and it was worse than everybody thought.
• 4:26
  SPEAKER_00: And ABC pulled the season.
• 4:30
  SPEAKER_01: Isn't A doesn't ABC own Disney?
• 4:32
  SPEAKER_01: Yes.
• 4:33
  SPEAKER_01: Like family fun, wholesome family fun.
• 4:37
  unknown: Yes.
• 4:37
  SPEAKER_01: And they are they they a whole season around this woman with a domestic violence charge.
• 4:43
  SPEAKER_00: Yeah.
• 4:44
  SPEAKER_00: And they knew about the domestic violence, and she had served her time, she had done probation, but just nobody realized how bad it was until the video surfaced.
• 4:51
  SPEAKER_00: And there's rumors that Dakota actually released the video.
• 4:55
  SPEAKER_01: Oh well, after someone threw metal stools at me, I'd release a video.
• 5:01
  SPEAKER_00: Right, right.
• 5:02
  SPEAKER_00: And so at first, when all this happened, it seemed like we would never see her season, but now it kind of seems like maybe.
• 5:11
  SPEAKER_00: It kind of seems like maybe we might see it.
• 5:14
  SPEAKER_01: Yeah.
• 5:15
  SPEAKER_00: Yeah.
• 5:15
  SPEAKER_01: No, I think I had a pharmaceutical representative, a former pharmaceutical representative, be a contestant on The Bachelor.
• 5:22
  SPEAKER_00: Which season do you remember?
• 5:23
  SPEAKER_01: I I don't remember, but this is ringing a bell now.
• 5:26
  SPEAKER_01: I think I did.
• 5:27
  SPEAKER_01: And that was exciting for all of Austin.
• 5:29
  SPEAKER_01: That we had a connection to The Bachelor.
• 5:32
  SPEAKER_00: Yeah, like representing, like Austin's representing.
• 5:36
  SPEAKER_01: Actually, you know what, Lisa?
• 5:37
  SPEAKER_01: One of the first bachelors was a guy who owned a couple of bars in Austin.
• 5:43
  SPEAKER_00: Oh I remember.
• 5:46
  SPEAKER_01: Yeah.
• 5:47
  SPEAKER_00: Yeah.
• 5:48
  SPEAKER_00: And he um, I forget his name.
• 5:51
  SPEAKER_00: I think he was The Bachelor twice.
• 5:54
  SPEAKER_01: God, I think you're right.
• 5:56
  SPEAKER_01: Actually, no, I think you're right.
• 5:57
  SPEAKER_01: Yeah.
• 5:57
  SPEAKER_00: I think he was The Bachelor twice.
• 5:59
  SPEAKER_00: And one of those seasons he chose Emily.
• 6:03
  SPEAKER_01: Uh-huh.
• 6:04
  SPEAKER_00: And yeah, I've been I've been proud member Bachelor Nation for a long, long, long time.
• 6:09
  SPEAKER_01: I can tell.
• 6:10
  SPEAKER_01: Yeah.
• 6:10
  SPEAKER_01: I can tell.
• 6:10
  SPEAKER_01: You really know your stuff.
• 6:12
  SPEAKER_01: Have you have you tried watching Love Island?
• 6:15
  SPEAKER_00: I haven't, but I've been told that maybe I should.
• 6:19
  SPEAKER_00: Is it good?
• 6:20
  SPEAKER_01: You know, you've got Bluey behind you in like a very wholesome looking um setting there.
• 6:27
  SPEAKER_01: And Love Island does does not fit in with that.
• 6:30
  SPEAKER_01: Um, it doesn't.
• 6:32
  SPEAKER_01: No.
• 6:32
  SPEAKER_01: I I would argue against watching Love Island.
• 6:36
  SPEAKER_01: Um I tried to watch a couple of episodes because my 22-year-old daughter said she loved it.
• 6:41
  SPEAKER_01: And I was like, well, I'm gonna try and watch it, trying to be a cool dad.
• 6:44
  SPEAKER_01: I couldn't even get through an episode.
• 6:46
  SPEAKER_01: Ooh, no bueno.
• 6:48
  SPEAKER_01: Oh, oh couldn't do it.
• 6:50
  SPEAKER_00: Couldn't do it.
• 6:51
  SPEAKER_00: Oh not family fun.
• 6:53
  SPEAKER_01: Not awesome family fun.
• 6:55
  SPEAKER_01: No.
• 6:56
  SPEAKER_01: Um, but but anyway, so you can put that on your list.
• 6:59
  SPEAKER_01: I tried.
• 7:00
  SPEAKER_01: I tried to do that.
• 7:00
  SPEAKER_00: You tried, and that that does make you a cool dad, Ted.
• 7:04
  SPEAKER_01: Yeah, I don't know.
• 7:06
  SPEAKER_01: I tried.
• 7:07
  SPEAKER_01: Um, and and then uh the you know, do you ever go back and watch Survivor?
• 7:13
  SPEAKER_00: No, I've never been much of a Survivor person.
• 7:16
  SPEAKER_00: So it's probably too late to catch up, right?
• 7:19
  SPEAKER_00: Hasn't there been like 50 seasons?
• 7:21
  SPEAKER_01: I think so.
• 7:22
  SPEAKER_01: I think that guy is still the same the same host for 50 seasons.
• 7:26
  SPEAKER_01: Yeah.
• 7:26
  SPEAKER_00: Yeah.
• 7:26
  SPEAKER_01: Um okay.
• 7:28
  SPEAKER_01: Well, less, look, uh, we could talk about this all day.
• 7:30
  SPEAKER_01: Um day.
• 7:32
  SPEAKER_01: Yeah.
• 7:32
  SPEAKER_01: And and now I really have to catch up with TFP and see what's going on with her.
• 7:36
  SPEAKER_01: Um, please do.
• 7:38
  SPEAKER_01: Yeah.
• 7:40
  SPEAKER_01: Speaking of itchy rashes, let's talk about atopic dermatitis, Dr.
• 7:45
  SPEAKER_01: Swanson.
• 7:46
  SPEAKER_00: Nice segue.
• 7:47
  SPEAKER_00: That was seamless.
• 7:48
  SPEAKER_00: That was seamless, Ted.
• 7:49
  unknown: Right.
• 7:50
  SPEAKER_01: Yeah.
• 7:50
  SPEAKER_01: That's what I'm known for.
• 7:52
  SPEAKER_01: Um, so pediatric indications and atopic dermatitis.
• 7:56
  SPEAKER_01: I know we've got um Zareve coming in at the two plus.
• 8:00
  SPEAKER_01: What else is is kind of floating your boat for atopic dermatitis that you'd like to talk about?
• 8:06
  SPEAKER_00: So much is floating my boat.
• 8:08
  SPEAKER_00: You know, so much.
• 8:09
  SPEAKER_00: I'm I'm unsinkable because there's so much floating my boat.
• 8:13
  SPEAKER_00: So Zareve is approved down to two, but soon to be down to three months.
• 8:18
  SPEAKER_00: We are expecting that soon.
• 8:21
  SPEAKER_00: And then uh, and Zareve, really nice vehicle, feels nice going on, very low burning and stinging rates.
• 8:27
  SPEAKER_00: We were all burned, pun intended, by our other PDE four inhibitor experience with Chris Aboral.
• 8:34
  SPEAKER_00: It's a completely different story with Zareve.
• 8:37
  SPEAKER_00: And then Vitama approved down to two.
• 8:40
  SPEAKER_00: Studies going down to three months are active now.
• 8:44
  SPEAKER_00: It is naturally derived, Ted.
• 8:47
  SPEAKER_00: Naturally derived.
• 8:48
  SPEAKER_01: From that war.
• 8:49
  SPEAKER_01: Yeah.
• 8:49
  SPEAKER_01: I remember the worm and the worm not dying.
• 8:51
  SPEAKER_01: And yes.
• 8:52
  SPEAKER_00: Yes, yes.
• 8:53
  SPEAKER_00: I feel like um the makers of Vtama need to have like a like a character, you know, like Vinny, Vinny the Vitama worm or something like that, or like Nelly the nematode, like something.
• 9:06
  SPEAKER_01: Oh yeah.
• 9:07
  SPEAKER_01: Nelly the nematode that never dies.
• 9:10
  SPEAKER_00: Dies.
• 9:11
  SPEAKER_00: Exactly.
• 9:11
  SPEAKER_00: Exactly.
• 9:12
  SPEAKER_00: Um, and Vitama, I think its claim to claims to fame are that it works really well for hands and feet, and it cannot get orally absorbed.
• 9:23
  SPEAKER_00: So for like two to four-year-olds that have eczema on their hands and they're constantly putting their hands in their mouth, uh, Vitama is a really nice choice.
• 9:31
  SPEAKER_00: And then um we have Obsolura approved down to two, our topical jack inhibitor for atopic dermatitis, works super, super, super fast.
• 9:40
  SPEAKER_00: It's got it's got speed in its corner and limited to 20% BSA application at a time, but that's that's not too big of a deal.
• 9:50
  SPEAKER_00: And then uh we it's got the box warning on it.
• 9:53
  SPEAKER_00: Have you heard my box warning spiel for Obsalura Ted?
• 9:57
  SPEAKER_01: Um, I have, but I think the entire Science of Skin Nation needs to hear your box warning spiel because it is so good.
• 10:05
  SPEAKER_00: Thank you.
• 10:05
  SPEAKER_00: Thank you.
• 10:06
  SPEAKER_00: So I tell families like Obsolura is in a family of medicines called the Jack Inhibitors.
• 10:11
  SPEAKER_00: Because of a study done on one of the pill jack inhibitors, the FDA thought it prudent to put a safety warning on all jack inhibitors, including our little topical obsolura.
• 10:20
  SPEAKER_00: Just because it's in the same family.
• 10:22
  SPEAKER_00: And when you think about it, obsolura is a lot like Kendall Jenner.
• 10:27
  SPEAKER_00: She's low drama, but she's in the same family as Kim and Chloe and Courtney and Kylie.
• 10:34
  SPEAKER_00: Higher drama.
• 10:35
  SPEAKER_01: Very high drama.
• 10:37
  SPEAKER_01: In fact, I just saw a headline from Pete from Saturday Night Live, who dated Kim for a little while.
• 10:45
  SPEAKER_00: Pete Davidson.
• 10:46
  SPEAKER_01: And Pete Davidson, thank you.
• 10:48
  SPEAKER_01: And he was saying what a wonderful person she was and how much he really enjoyed the relationship and all of that.
• 10:53
  SPEAKER_01: So, and did you know that Kim is she may be an attorney or trying to be an attorney?
• 10:58
  SPEAKER_00: She passed the bar, and I think she wants to like help people who have been like wrongly convicted or something, I think.
• 11:10
  SPEAKER_00: Yeah, yeah.
• 11:11
  SPEAKER_01: Okay, okay, snap, snap, snap, snap, snap, snap.
• 11:13
  SPEAKER_00: So good.
• 11:14
  SPEAKER_00: Yeah.
• 11:14
  SPEAKER_00: Thank you, Kim.
• 11:15
  unknown: Yeah.
• 11:15
  SPEAKER_01: Um, okay.
• 11:16
  SPEAKER_00: Well, that oh, she hasn't.
• 11:19
  SPEAKER_00: Thank you, Lou, for chiming in.
• 11:20
  SPEAKER_00: That's an important fact check.
• 11:22
  SPEAKER_01: Yeah.
• 11:22
  SPEAKER_01: So producer Lou just chimed in and let us know, let us know that Kim has not passed the bar, but we wish her the best.
• 11:29
  SPEAKER_00: I'm impressed that of the three of us, producer Lou was the one that knew that.
• 11:34
  SPEAKER_00: She he was up to date, Ted, and neither of us were.
• 11:37
  SPEAKER_01: But he watches Love Island.
• 11:38
  SPEAKER_01: Okay, let's talk about psoriasis now.
• 11:42
  SPEAKER_01: Dr.
• 11:42
  SPEAKER_01: Swanson, what can you tell us about psoriasis?
• 11:46
  SPEAKER_00: I can tell you so much.
• 11:47
  SPEAKER_00: Well, I can't tell you anything, Ted, because you know psoriasis so, so well.
• 11:52
  SPEAKER_00: But I can tell our listeners a few little tidbits of information from the pediatric space.
• 11:58
  SPEAKER_00: So, number one, we have xerive point three cream approved down to six, soon to be two.
• 12:04
  SPEAKER_00: So we're anticipating label expansion for pediatric psoriasis.
• 12:08
  SPEAKER_00: We have xerif point three foam approved for sebderm down to nine, psoriasis down to 12.
• 12:14
  SPEAKER_00: So sometimes my nine to 11 year olds, it's hard to tell if they have psoriasis or sebderm.
• 12:21
  SPEAKER_01: Right.
• 12:21
  SPEAKER_00: Right, Ted?
• 12:22
  SPEAKER_00: Are you picking up what I'm laying down?
• 12:23
  SPEAKER_00: Uh-huh.
• 12:24
  SPEAKER_00: Yeah.
• 12:24
  SPEAKER_01: Uh-huh.
• 12:24
  SPEAKER_01: Yeah.
• 12:25
  SPEAKER_00: Um, and then we have Gasel Q Mabtrymphia that was approved down to age six.
• 12:30
  SPEAKER_00: Now you have to weigh 40 kilograms, which is 88 pounds.
• 12:34
  SPEAKER_00: But the number one associated comorbidity of pediatric psoriasis is obesity.
• 12:39
  SPEAKER_00: So we might see, you know, some six, seven, eight, nine-year-olds that meet that weight restriction or weight criteria.
• 12:46
  SPEAKER_00: And then ICO, ICOTIde, big deal.
• 12:50
  SPEAKER_00: You and I both know this is a big deal.
• 12:53
  SPEAKER_00: Um, it is a pill, IL-23 inhibitor.
• 12:56
  SPEAKER_00: It binds to the receptor.
• 12:58
  SPEAKER_00: And they said it couldn't be done.
• 12:59
  SPEAKER_00: We won't have biologic mechanism of action in a pill.
• 13:02
  SPEAKER_00: And now science is amazing.
• 13:04
  SPEAKER_00: And here we have it, and it's a once-a-day pill.
• 13:07
  SPEAKER_00: Now, Ted, the pill can be dissolved in water, which is good because it's it's big.
• 13:14
  SPEAKER_00: Do you know how big the ICO pill is?
• 13:16
  SPEAKER_01: I do.
• 13:17
  SPEAKER_01: And if I can make one small correction, and I and I just need to say this they don't say dissolved, they say dispersed in water.
• 13:24
  SPEAKER_00: Dispersed.
• 13:25
  SPEAKER_00: Thank you for creating the water.
• 13:26
  SPEAKER_01: So it gets dispersed.
• 13:28
  SPEAKER_00: That's an important distinction.
• 13:30
  SPEAKER_01: And um uh this it's the size of the pill is like a multivitamin.
• 13:35
  SPEAKER_00: Yeah, it's 18 millimeters, which is, I mean, that's kind of big.
• 13:40
  SPEAKER_00: So it's nice that there's the option to dissolve in water, but I call ICO the no butts medicine.
• 13:48
  SPEAKER_00: Like biologics work well and are very safe, but they're a shot.
• 13:53
  SPEAKER_00: Our oral medicines for psoriasis are pills, but you might have diarrhea and they might not work very well.
• 14:01
  SPEAKER_00: Whereas ICO, there's no butts.
• 14:04
  SPEAKER_01: Right.
• 14:04
  SPEAKER_01: Although if you have psoriasis on your butt, ICO will probably work.
• 14:08
  SPEAKER_00: That's true.
• 14:09
  SPEAKER_00: I think it would work actually quite well for psoriasis on the butt.
• 14:13
  SPEAKER_01: Yeah.
• 14:13
  SPEAKER_01: Yeah.
• 14:14
  SPEAKER_01: And and and so ICO is such an interesting, I mean, we could talk all day about ICO.
• 14:17
  SPEAKER_01: It's it's a peptide.
• 14:19
  SPEAKER_01: It's just an amazing new uh molecule.
• 14:22
  SPEAKER_01: Um but that's that's great.
• 14:24
  SPEAKER_01: Okay, so we went through the topical and the systemic options for psoriasis.
• 14:30
  SPEAKER_01: Now, Dr.
• 14:30
  SPEAKER_01: Swanson, are you prescribing any GLP1s for your obese psoriasis patients?
• 14:37
  SPEAKER_00: That's a good question.
• 14:38
  SPEAKER_00: I am open to it for both psoriasis and for HS.
• 14:42
  SPEAKER_01: Yes.
• 14:43
  SPEAKER_00: I haven't had a patient want to take that journey with me yet.
• 14:48
  SPEAKER_00: Now, most of my patients are under 18, and there's only one that's approved down to 12.
• 14:54
  SPEAKER_00: I think it's Ozempic.
• 14:55
  SPEAKER_00: Is it Ozempic?
• 14:57
  SPEAKER_01: Semaglutide, yeah.
• 14:58
  SPEAKER_00: Yeah.
• 14:59
  SPEAKER_00: Um, and so I mention it now in my list of options, probably more for HS even than I than I mention it for psoriasis.
• 15:08
  SPEAKER_00: But I'm I'm open to it, I am willing to it, I am, I am all about it, but I haven't had any takers yet.
• 15:15
  SPEAKER_00: Yeah.
• 15:15
  SPEAKER_00: Have you have you dabbled?
• 15:16
  SPEAKER_00: Are you dabbling?
• 15:17
  SPEAKER_01: We we did, and we ran a trial, we're running a trial for Lily where it's TALTS plus terzepitide, and they already have a trial, then they published the the results showing that there's such a synergy between the two of them uh in terms of PASI improvement.
• 15:32
  SPEAKER_01: So it's super exciting to start thinking about GLP1s is not only for weight loss, but as we know, there's so many amazing opportunities to help with metabolic health and and systemic inflammation.
• 15:44
  SPEAKER_01: So um we had Lindsay Bourdeau on the podcast, and and if anybody's interested, Lindsay's episode about the systemic improvements related to GLP1 receptor agonists is just unbelievable.
• 15:56
  SPEAKER_00: So you know what I feel like I'm hearing more about with for with um regards to the GLP1s, Ted, is kind of like the the sad mood, like the m malaise.
• 16:07
  SPEAKER_00: Have you seen that?
• 16:08
  SPEAKER_00: Like some people say that like they're they're losing weight and they're happy about that, but like they're not as joyful.
• 16:15
  SPEAKER_00: Have you seen that?
• 16:16
  SPEAKER_01: I haven't seen that.
• 16:16
  SPEAKER_01: I mean, uh if you look at the data, there's actually some improvement in in depression as well.
• 16:20
  SPEAKER_01: Oh in major depression disorder with GLP1.
• 16:23
  SPEAKER_01: So that I haven't seen that, but I will certainly keep an eye out for it.
• 16:26
  SPEAKER_01: Is that is that like anecdotal, or did you read something about that?
• 16:29
  SPEAKER_00: No, I feel like I'm hearing about it everywhere.
• 16:33
  SPEAKER_00: Yeah, yeah.
• 16:34
  SPEAKER_00: Um, and people are still sticking with it because like overall the benefits are outweighing that, but a lot of people will notice that they get a little like blues, they get the blues.
• 16:44
  SPEAKER_01: Okay.
• 16:45
  SPEAKER_01: I'll I'll I'll check that out.
• 16:46
  SPEAKER_01: I haven't seen that.
• 16:47
  SPEAKER_01: Thank you for letting me know.
• 16:49
  SPEAKER_00: And that's very different from getting the blueies, which is happy.
• 16:52
  SPEAKER_01: Yes, which yes, blueies are happy.
• 16:54
  SPEAKER_01: Yeah, the blues are not.
• 16:57
  SPEAKER_01: Um, yeah, got it.
• 16:58
  SPEAKER_01: Okay, so now we're going to move on.
• 17:01
  SPEAKER_01: Dr.
• 17:01
  SPEAKER_01: Swanson, please tell us about the pediatric update for alopecia areata.
• 17:06
  SPEAKER_00: Oh, so alopecia areata, we need to be jumping on alopecia areata.
• 17:14
  SPEAKER_01: Right.
• 17:14
  SPEAKER_00: And right now we only have one jack inhibitor approved down to the age of 12.
• 17:20
  SPEAKER_00: We have two approved to 18.
• 17:22
  SPEAKER_00: One of those Illuminant has data down to 12.
• 17:26
  SPEAKER_00: We are eagerly awaiting the approval of Rinvoke for alopecia areata, and they studied down to 12, so I'm hopeful it'll be down to 12.
• 17:33
  SPEAKER_00: But the thing is, is that we are learning and appreciating that we need to be talking about Jack inhibitors for allopiciata earlier with our patients and their families.
• 17:47
  SPEAKER_00: There have been three studies that I think prove the point that earlier intervention is key.
• 17:54
  SPEAKER_00: So, study number one was a study on aluminum in teenagers, and they found that the percentage of patients able to achieve saltless 30 Hula 20 was twice as good in the patients with less than two years disease duration compared to those with longer disease durations.
• 18:15
  SPEAKER_00: Study number two was on Litful, where they included patients down to 25% alopecia.
• 18:23
  SPEAKER_00: So most of these studies, you have to have at least 50% alopecia areas to qualify.
• 18:28
  SPEAKER_00: This one included down to 25%.
• 18:30
  SPEAKER_00: And the more mild your alopecia areata, the better your success is on the medicine.
• 18:36
  SPEAKER_00: Number three, also to do with alumniant.
• 18:39
  SPEAKER_00: In the patients on alumniant from the adult trials, if they achieved success, salt less than or equal to 20, they were re-randomized to either stay on Illuminant or be withdrawn to placebo.
• 18:51
  SPEAKER_00: And while it makes me so sad for the patients that regrew their hair and then were withdrawn, makes me so sad to think about them.
• 19:00
  SPEAKER_00: It also gave us very useful information.
• 19:04
  SPEAKER_00: About 80% of the folks who got off of the medicine, who were withdrawn from treatment, lost their hair again.
• 19:10
  SPEAKER_00: But 20% didn't for a year.
• 19:14
  SPEAKER_00: So what was special about that 20%?
• 19:16
  SPEAKER_00: They had patchy alopiciariata, not totalis or universalis, and they had less than four years disease duration.
• 19:24
  SPEAKER_00: So all of this is telling us we've we need to introduce this earlier.
• 19:29
  SPEAKER_00: We've been like saving these jack inhibitors for the worst case scenario if everything else fails.
• 19:35
  SPEAKER_00: We shouldn't do that.
• 19:36
  SPEAKER_00: We should be jumping in.
• 19:38
  SPEAKER_00: And so even though these jacks are off label in the younger space, I'm doing it.
• 19:43
  SPEAKER_00: Other PSDRMs are doing it.
• 19:45
  SPEAKER_00: And I think it's important to try to help these kids.
• 19:49
  SPEAKER_01: Is there a salt score, like a lower limit salt score that will allow you to kind of trigger your desire to start a Jack?
• 19:58
  SPEAKER_01: You know, because on label it's salt 50 or greater.
• 20:00
  SPEAKER_01: What about what is the Dr.
• 20:01
  SPEAKER_01: Swanson way?
• 20:03
  SPEAKER_00: I think, I mean, of course, in my note to help get medicines approved, I'm documenting a salt greater than or equal to 50.
• 20:12
  SPEAKER_00: Um, but it there's more to factor in.
• 20:16
  SPEAKER_00: It's kind of like the lessons we've learned from like eczema.
• 20:19
  SPEAKER_00: Like there's more than just BSA.
• 20:22
  SPEAKER_00: There's more than just, you know, IGA score.
• 20:25
  SPEAKER_00: It's how is the patient experiencing the disease?
• 20:29
  SPEAKER_00: If I have a teenager with SALT 25, but they're not going to school anymore, then that's really impactful to me and I want to help them.
• 20:40
  SPEAKER_00: I I often tell when I'm giving lectures to dermatology clinicians, I really encourage encourage everybody to get on the Jack bandwagon for alopiciariata.
• 20:49
  SPEAKER_00: And I tell them treating alopiciariata patients with JAC inhibitors is going to change your life, the life of the practitioner, because they're my most joyful moments in clinic when I walk in and a person who previously was like in a shell because of their alopiciariata, and now they're smiling at me and they keep talking to me and they keep telling me stories.
• 21:12
  SPEAKER_00: It's just the best, Ted.
• 21:14
  SPEAKER_00: It's the best.
• 21:15
  SPEAKER_01: Yeah.
• 21:16
  SPEAKER_01: I completely agree, Lisa.
• 21:17
  SPEAKER_01: I think that hopefully everyone's getting more and more familiar with Jax, comfortable with Jax, the safety profile of Jax.
• 21:25
  SPEAKER_01: We know that the longer that they're out, they seem to be safer and safer in terms of the incidence of AEs, the severity of AEs is not going up that I know of.
• 21:33
  SPEAKER_01: And so I just think that unfortunately they got somewhat of a bad rap based on that tofacitinib trial that you mentioned.
• 21:40
  SPEAKER_01: And it's a different, you know, usually our AD pa's AD, our alopecia area patients are younger, they're super healthy.
• 21:47
  SPEAKER_01: Um, and so it's kind of a great population.
• 21:50
  SPEAKER_01: If you want to dip your toe in the jackpool, then this is a great population to start with.
• 21:55
  SPEAKER_01: And my goodness, as you said, what a great way to help somebody.
• 22:00
  SPEAKER_01: You know, psychosocially um more than anything because it's so devastating.
• 22:04
  SPEAKER_01: We all know how devastating it is.
• 22:06
  SPEAKER_01: We see these poor patients.
• 22:07
  SPEAKER_00: Well, and I tell folks who are Jack hesitant, I tell them start with an alopecia eriata patient because they are so profoundly thankful.
• 22:16
  SPEAKER_00: It's such a wonderful journey to take with your patient.
• 22:18
  SPEAKER_00: And also I feel like you could read the contents in the entire contents of the box warning to a patient with alopecia ariata in an ominous tone.
• 22:30
  SPEAKER_00: And at the end of that, the patient will be like, okay, yeah, can we start today?
• 22:36
  SPEAKER_01: That's so true.
• 22:38
  SPEAKER_01: That's so true.
• 22:39
  SPEAKER_01: I love that.
• 22:40
  SPEAKER_00: So it's a good one to start with.
• 22:42
  SPEAKER_00: And I think once you do it a couple times, oh my gosh, the joy you bring to these patients, and therefore the joy you bring to yourself.
• 22:48
  SPEAKER_00: It's selfish, really, to treat patients with the allop charioto with jack inhibitors because it's it's career affirming.
• 22:55
  SPEAKER_00: It just makes me so happy.
• 22:58
  SPEAKER_01: Perfect.
• 22:59
  SPEAKER_01: Can I pivot real quick?
• 23:01
  SPEAKER_01: Because we don't have much time with you, and I want to make sure we get as many pearls as we possibly can.
• 23:06
  SPEAKER_01: Yes.
• 23:06
  SPEAKER_01: For your pediatric female acne patients.
• 23:10
  SPEAKER_00: Yes.
• 23:11
  SPEAKER_01: Do you treat with spironolactone?
• 23:13
  SPEAKER_00: Yes.
• 23:14
  SPEAKER_00: Okay.
• 23:15
  SPEAKER_01: And what age do you think is the, again, the lower limit of starting spironolactone?
• 23:20
  SPEAKER_00: Well, you want them to have at least started their period.
• 23:22
  SPEAKER_00: And some people say you want them to have their period for at least two years.
• 23:26
  SPEAKER_00: Um, the same guidelines hold for birth control pills.
• 23:30
  SPEAKER_00: I am okay with that, but also if I have a patient who's, you know, they've been having their period for a year and we talk through the options, and either a birth control pill or sporonal lactone seems appealing to them, I'm on board with that.
• 23:44
  SPEAKER_00: I I don't stick, I don't stick hard to the two-year rule rule, but those are kind of the general guidelines.
• 23:50
  SPEAKER_01: Okay.
• 23:51
  SPEAKER_01: And in terms of dosing, Lisa, can you give us an idea of what like is a good starting dose for a 13, 14, 15-year-old?
• 23:57
  SPEAKER_00: Yes.
• 23:58
  SPEAKER_00: So I start with 50 milligrams a day and I tell them that most of my patients do great with that.
• 24:02
  SPEAKER_00: And if they don't, we can go up to 100.
• 24:04
  SPEAKER_00: And it's super well tolerated.
• 24:06
  SPEAKER_00: It can make their periods irregular.
• 24:09
  SPEAKER_00: And so I warn them about that.
• 24:11
  SPEAKER_00: And sometimes that's not a big deal.
• 24:12
  SPEAKER_00: Sometimes their periods are irregular already, and so it doesn't really add any issues to it.
• 24:17
  SPEAKER_00: Um, but that's the one side effect I do mention to them.
• 24:20
  SPEAKER_01: Amazing.
• 24:20
  SPEAKER_01: Thank you.
• 24:21
  SPEAKER_01: Um, let's talk about hemangiomas.
• 24:24
  SPEAKER_00: Uh, yay!
• 24:25
  SPEAKER_01: Yay, I know.
• 24:26
  SPEAKER_01: And I don't know why I'm so scared of treating hemangiomas, and so I always turf them to my favorite pediatric dermatologist.
• 24:34
  SPEAKER_01: Um, but but tell us about how you are treating hemangiomas right now.
• 24:38
  SPEAKER_00: Yes, so hemangiomas are near and dear to my heart, Ted, because I I had three hemangiomas on my face when I was a baby.
• 24:46
  SPEAKER_00: And so my mom tells me I was destined to be a pediatric dermatologist because me and hemangiomas go way back.
• 24:52
  SPEAKER_00: She said that and my horrible diaper rash.
• 24:55
  SPEAKER_00: I'm like, thanks, mom.
• 24:56
  SPEAKER_00: That's really, really nice.
• 24:58
  SPEAKER_00: From head to toe.
• 24:59
  SPEAKER_00: Um, but hemangiomas are so fun to treat because the treatments are super safe and super effective, and it's really, really helpful for these babies.
• 25:10
  SPEAKER_00: And so you want to treat during the first year of life because that's the potential growth phase of the hemangioma.
• 25:16
  SPEAKER_00: That's when the medicines work the best.
• 25:19
  SPEAKER_00: We basically have three options.
• 25:21
  SPEAKER_00: We have topical timolol, where I prescribe the 0.5% gel-forming solution.
• 25:27
  SPEAKER_00: It's an eye drop used for glaucoma, but you can do a drop on your fingertip, apply it to the hemangioma.
• 25:33
  SPEAKER_00: Now, topical timolol only works for superficial hemangiomas.
• 25:38
  SPEAKER_00: So we've got superficial hemangiomas, which are like a strawberry on the surface.
• 25:43
  SPEAKER_00: We've got deep hemangiomas, which are a blue bump under the skin, and then we have combined, where it's a blue bump with a strawberry on top.
• 25:50
  SPEAKER_00: Timolol only works for the superficial, and you never want to use timolol on an ulcerating hemangioma because you get unpredictable systemic absorption through the ulceration.
• 26:02
  SPEAKER_00: Then we have propranolol, and there's a brand name version called hemangiol, and this is dosed twice a day, very, very safe.
• 26:09
  SPEAKER_00: The most important thing with propranolol, always give with food in baby's tummies because propranolol can make blood sugars go low.
• 26:17
  SPEAKER_00: So if you're always giving with food, that's not going to happen.
• 26:20
  SPEAKER_00: And that's probably the big, the big deal about propranolol.
• 26:23
  SPEAKER_00: One other thing I'll share about propranolol before moving on to Natalol is that in the early days of propranolol for hemangiomas, I would ask any pediatric cardiologist I ran into, are we out of our domain?
• 26:35
  SPEAKER_00: Are we out of our scope?
• 26:37
  SPEAKER_00: Are we crazy to be prescribing propranolol to babies?
• 26:41
  SPEAKER_00: And one pediatric cardiologist said it the best way I can think of.
• 26:44
  SPEAKER_00: He said, In the doses you guys are using, I would prescribe propranolol for a baby I had never met, and I would never follow up.
• 26:53
  SPEAKER_01: Okay.
• 26:54
  SPEAKER_01: Okay, what a cowboy.
• 26:56
  SPEAKER_01: Okay.
• 26:56
  SPEAKER_00: I know.
• 26:57
  SPEAKER_00: It's just that safe in the doses we use, which is two makes per cake per day divided twice a day.
• 27:03
  SPEAKER_00: And then we have Natalol, which was studied by our Canadian friends to the north.
• 27:08
  SPEAKER_00: Oh.
• 27:09
  SPEAKER_00: And they determined that natilol was even more effective than propranolol, which is true.
• 27:13
  SPEAKER_00: I've had a lot of experience with it.
• 27:15
  SPEAKER_00: Natalol has two caveats, it has to be compounded, which isn't awful because then you can choose the flavor.
• 27:21
  SPEAKER_00: And then natilol is excreted in the poo-poo.
• 27:24
  SPEAKER_00: If a baby gets constipated, it can't get out, and then there's too much natilol in the baby.
• 27:29
  SPEAKER_00: So I tell patients and families if your baby hasn't pooped for three days, stop the medicine.
• 27:34
  SPEAKER_00: Once your baby poops, you can restart the medicine.
• 27:37
  SPEAKER_01: That is an unhappy baby if they're not pooping.
• 27:39
  SPEAKER_00: Unhappy baby.
• 27:40
  SPEAKER_00: Yeah.
• 27:42
  SPEAKER_00: Yes.
• 27:43
  SPEAKER_01: Okay.
• 27:44
  SPEAKER_01: Thank you so much, Lisa.
• 27:45
  SPEAKER_01: That was like such a quick 101 on homangiomas.
• 27:48
  SPEAKER_01: That's amazing.
• 27:49
  SPEAKER_01: And finally, last but certainly not least, the bane of many dermatologists' existence, molluscum.
• 27:57
  SPEAKER_00: Yeah.
• 27:58
  SPEAKER_00: I knew anytime somebody says the bane of dermatology existence, I'm like molluscum.
• 28:03
  SPEAKER_00: Yes, yes.
• 28:04
  SPEAKER_00: Um, I mean, we've got some new stuff from Molluscum.
• 28:07
  SPEAKER_00: So we've got the branded form of Cantheridin in the beautiful purple color.
• 28:12
  SPEAKER_00: I call it lavender haze.
• 28:14
  SPEAKER_00: I'm a Swifty.
• 28:15
  SPEAKER_00: Oh, you're a Swifty.
• 28:16
  SPEAKER_01: Oh my gosh.
• 28:17
  SPEAKER_01: We have not mentioned Taylor yet.
• 28:20
  SPEAKER_01: What is wrong with us?
• 28:22
  SPEAKER_00: This has been like over 25 minutes, and I haven't mentioned Taylor.
• 28:26
  SPEAKER_00: What's wrong with me, Ted?
• 28:27
  SPEAKER_01: I am I oh no.
• 28:29
  SPEAKER_01: Do you have a thermometer in there?
• 28:31
  SPEAKER_01: Take your temperature.
• 28:32
  SPEAKER_00: Check me.
• 28:32
  SPEAKER_00: Do I have a fever?
• 28:34
  SPEAKER_00: Um, and so we have the Brandon Kentheridin in beautiful lavender haze, and then we have Berdazimer Gel, which is a topical nitric oxide-releasing gel applied at home.
• 28:44
  SPEAKER_00: I will say I have been impressed with its efficacy.
• 28:48
  SPEAKER_00: There are two kinds of things about it that have been a little bit troublesome.
• 28:53
  SPEAKER_00: Number one, it will sometimes create a little bit of burning and stinging.
• 28:57
  SPEAKER_00: Most of my patients have been cool with it because they they like that their molluscum are doing something and going away, but sometimes some burning and stinging.
• 29:06
  SPEAKER_00: And then number two, access has been a bit of a journey with the birdasimer.
• 29:10
  SPEAKER_00: I think it's getting better.
• 29:11
  SPEAKER_00: It's been out around a year now.
• 29:13
  SPEAKER_00: So hopefully, you know, hopefully it's getting better.
• 29:15
  SPEAKER_00: But the interesting thing with molluscum Ted, like there have been some natural therapies for molluscum in the past, like tea tree oil and zymoderm and molluscum RX.
• 29:27
  SPEAKER_00: And for eczema, all our patients and their parents want is something natural.
• 29:32
  SPEAKER_00: But for molluscum, they want the most aggressive, most annihilating, most destructive.
• 29:39
  SPEAKER_00: Yeah.
• 29:39
  SPEAKER_00: They want the molluscum to die and they want them to suffer.
• 29:43
  SPEAKER_01: Yeah.
• 29:44
  SPEAKER_00: So nobody was choosing these natural therapies.
• 29:48
  SPEAKER_00: And now it's great that we have this branded Kentheridin and this birdasimer gel.
• 29:52
  SPEAKER_01: Amazing.
• 29:53
  SPEAKER_01: Yeah.
• 29:54
  SPEAKER_01: So in your hands, then you're finding the birdasimer maybe a little bit more effective than the branded Kentheridin?
• 30:00
  SPEAKER_00: Yes.
• 30:01
  SPEAKER_00: I really, you know, and the study data did not show that.
• 30:04
  SPEAKER_00: Like birdasimer's study data was just kind of okay.
• 30:08
  SPEAKER_00: In real life, I found it to be quite effective, but sometimes a little burning and stinging, and sometimes some access issues.
• 30:15
  SPEAKER_01: Oh my gosh, Lisa, it's time.
• 30:17
  SPEAKER_01: I we have to do this again.
• 30:19
  SPEAKER_01: I love it so much whenever we get to spend time with each other.
• 30:21
  SPEAKER_01: I know.
• 30:23
  SPEAKER_01: You're the best.
• 30:23
  SPEAKER_01: So that was Dr.
• 30:24
  SPEAKER_01: Lisa Swanson, everybody.
• 30:25
  SPEAKER_01: She's a dermatologist at Ada West Dermatology.
• 30:28
  SPEAKER_01: She's also affiliated with St.
• 30:29
  SPEAKER_01: Luke's Children's Hospital.
• 30:31
  SPEAKER_01: She will be on another podcast, on a podium.
• 30:34
  SPEAKER_01: You can find Lisa in many places because everybody absolutely adores her, and she's such a wonderful expert in pediatric dermatology, as well as live TV.
• 30:43
  SPEAKER_01: As well, I mean, not live TV, you know what I mean.
• 30:47
  SPEAKER_01: As well as Taylor Swift.
• 30:49
  SPEAKER_01: So, Lisa, thank you so much.
• 30:51
  SPEAKER_01: I really appreciate your telling.
• 30:52
  SPEAKER_00: Thank you so much, Ted.
• 30:54
  SPEAKER_00: It's been an honor and a privilege.
• 30:56
  SPEAKER_00: I really feel so happy that you invited me on the pod.
• 30:58
  SPEAKER_00: Thank you.
• 30:59
  SPEAKER_01: Oh, it was the best.
• 30:59
  SPEAKER_01: It was the best.
• 31:00
  SPEAKER_01: Thank you so much for listening, everybody.
• 31:02
  SPEAKER_01: Um, and don't forget Science of Skin Summit taking place September 17th through the 20th in Austin, Texas this year.
• 31:09
  SPEAKER_01: And then we've got our longevity conference, February 19th through the 21st in Scottsdale, Arizona.
• 31:13
  SPEAKER_01: You can find out more at Science of Skinsummit.com.
• 31:16
  SPEAKER_01: Thank you so much for listening.