Insights on Acne and Rosacea Treatment with James Del Rosso, DO

At the annual Maui Derm NP+PA Fall meeting in Nashville, Tennessee, James Del Rosso, DO, research director and principal investigator at JDR Dermatology Research in Las Vegas, Nevada, and president of the American Acne and Rosacea Society, talked about the latest in his approach to treating acne and rosacea.

Del Rosso, joined by Hilary Baldwin, MD, and Julie Harper, MD, delved into several insightful cases highlighting the challenges and successes they’ve found in treating each condition.

TRANSCRIPT

Del Rosso: Hello, I'm Dr. Jim Del Rosso in Las Vegas, Nevada, where I am research director and principal investigator at JDR Dermatology Research, which is also affiliated with Thomas Dermatology. I am very happy about the opportunity to present at the Maui Derm Nurse Practitioner Physician Assistant meeting that was held at the Gaylord Hotel in Nashville, Tennessee. Very exciting. I love that city, and it's a great opportunity to get involved with teaching.

Dermatology Times: What topics will you address in your presentation at Maui Derm NP+PA Fall 2024?

Del Rosso: At this meeting in Nashville, I have the benefit of being with Dr. Julie Harper and Dr. Hillary Baldwin together on a program that addresses acne and rosacea. I am currently the president of the American Acne and Rosacea Society for my second round of doing that. Dr. Baldwin and Dr. Harper have also been past presidents, and these are subject areas that we've all been very involved with. So, I'm very happy about being part of the session. Now, the session has a fair amount of opportunity for dialog between the 3 of us, when someone's presenting a case or a particular area, it gets opened up for discussion. Each of us can give our own perceptions or try to add to what the other has discussed. It's not just a sequence of talking heads only. There's an interactive discussion.

DT: What cases did you bring forward for discussion?

Del Rosso: I have 2 cases that I'm presenting after first going over some of the activities of the American Acne and Rosacea Society and addressing where we are right now. Even though not a lot has changed, there's been some new information:Where we are right now with that petition to the FDA about benzoyl peroxide, with benzene being found in benzoyl peroxide products, and what some of the publications and discussions have said. A succinct but thorough update on that. I'm presenting 2 cases. The first case is a patient that had frequently recurrent acne that was effectively treated, eventually went on oral isotretinoin. They were a young teenager, and then as this case moved on, over time, became post teen, but still was dealing with recurrent acne after repeated uses of oral isotretinoin. It evaluates the case in terms of what was done, what might have been done differently and how to think through the case. Ultimately, the patient was very thin, was a very finicky eater, did not want to use benzoyl peroxide, was a strict vegan, didn't eat much fat at all. There were a lot of challenges in that regard, and they would get better but then a year and a half, 2 years later, their acne would all come back. There were factors to look at in this case: Whether it was the formulation of isotretinoin, trying to use one that isn't dependent on fat for absorption, or is something else going on. It turned out the patient had polycystic ovary syndrome, or polycystic ovary disease, and it works through the challenges and how there's a lot to update this subject area. It's different than what we had thought and understood in the past. It's an equal opportunity disease. It can be someone who's small, someone who's large, someone who's overweight, obviously a female, and they could be any race, color, or creed. It was very instructive. The second case is a situation we all encounter if we practice with other clinicians, whether it be other dermatologists, nurse practitioners, or physician assistants. They happen to be out of the office, and I was seeing a patient that they typically see in a follow up. The patient is asking for medications that needed refillsthat the other clinician had been giving them. This is a situationin particular that comes up in regard to doing thatversus thinking through the case and seeing if you would want to do something different. Seeing if something else is going on. It turned out to be a patient that had been on oral minocycline for some time for rosacea, that had been what had helped them to control their disease. In conversation, it turned out that the patient was going to be seeing a rheumatologist for some periodic swelling and discomfort in the small joints of her hands. It ended up that that patient had drug associated lupus like syndrome, didn't really have any skin manifestations, and that's something that you can occasionally see with minocycline. It easily could have slipped by in just refilling the prescription, or not by happenstance, getting some information of what that patient is doing. In talking to that patient: “How are you doing?” “Oh,I'm doing great. It works great,” but not thinking about the other things they have going on that they don't think of as being related to a dermatology visit. It turned out it was, so I suspected. I got a note and asked her to give the note to a rheumatologist. The rheumatologist called me, and we worked on it together. It turned out that it was minocycline related lupus like syndrome, which is uncommon but can occasionally be seen, and we were able to resolve it in this case. Two very instructive cases that brought up good discussion, and it was a pleasure to have the opportunity to do it, to network with everyone else there and see people that I know. To have 1 on 1 discussions with people attending the meeting that have questions on the presentation, or with dermatology in general. That's where I think a lot of the magic happens is those 1 on 1 discussions with people at the meeting. It's not only the lecture sessions or the presentation sessions, it's the entire package. A good time, a fun time, and a very educationally worth wild meeting.

[This transcript has been edited for clarity.]