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That “sandpaper” patch you keep rubbing might be more than dry skin. We sit down with board-certified dermatologist Dr. David Cleaver to talk about sun damage, actinic keratoses, and why outdoor life in rural communities can quietly build a lifetime of precancerous change. If you have a history of tanning, years of farm work, construction, or just a lot of time outside, this conversation will help you connect the dots between chronic UV exposure and the day-to-day reality of prevention. We dig into photodynamic therapy (PDT), a light treatment that targets a whole field of sun-damaged skin, not just the spots you can see. We compare PDT with liquid nitrogen freezing and topical field therapy creams like 5-fluorouracil and imiquimod, including why “less homework” can matter for real patients with real schedules. We also break down red light versus blue light PDT, how depth of penetration plays into the choice, and why many practices treat more often in fall and winter when sun avoidance is easier. You will hear the honest version of the patient experience too: incubation time, what the light can feel like, how cooling devices and protocol tweaks can improve comfort, and what recovery looks like over the following one to two weeks. We also talk about newer directions, including FDA-approved red light use for superficial basal cell carcinoma in select cases, plus other emerging and off-label areas dermatologists are watching. If you want practical skin cancer prevention that goes beyond “watch and wait,” press play. Subscribe, share this with someone who lives outdoors, and leave a review to help more people find it. What would you want to know before trying PDT? 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.

Most skincare and dermatology treatments don’t fail because the medicine is weak. They fail because real life is messy, routines are hard, and “use this twice a day” turns into “I’ll start tomorrow.” We sit down with returning guest Dr. Steve Feldman, a board-certified dermatologist and dermatopathologist who researches medication adherence, to unpack what actually happens between the prescription and the bathroom counter. We talk candidly about why topical treatments for psoriasis and eczema are uniquely challenging, how objective tracking (like smart bottle caps) changed what we thought we knew, and why the mindset shift matters: don’t blame the patient, redesign the system. Dr. Feldman shares behavior-based tactics you can use immediately, including environmental cues, written instructions, simpler dosing, and why frequent follow-up works like piano lessons. If you’ve ever felt guilty about not using a cream exactly as directed, this conversation replaces shame with strategy. A highlight is the “three-day sprint” approach for scalp psoriasis using clobetasol, built around short timelines, realistic coaching, and accountability that mirrors why people floss right before the dentist. We also explore the future of patient engagement with AI in healthcare, including automated check-ins that may feel surprisingly supportive, plus persuasion tools like anchoring and the outsized power of a single story. If you care about better outcomes in dermatology, skincare routines, and patient-centered care, hit play, then subscribe, share this with a friend who’s struggling with a regimen, and leave a review with your biggest adherence challenge. 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.

A painful lump in your armpit is bad enough. Now imagine it keeps coming back, forming tunnels under the skin, draining on your schedule instead of yours, and forcing you to plan your day around bandages and friction. That’s the reality for many people living with hidradenitis suppurativa (HS), and it’s why we wanted a clear, practical conversation about procedures that can actually help. We’re joined by Dr. Nader Aboul-Fettouh, a board-certified dermatologist and Mohs surgeon, to break down what HS is at the follicle level and why chronic inflammation leads to nodules, abscesses, scarring, and sinus tracts. Then we get specific about HS procedures and where they fit alongside modern medical therapy like biologics. We talk through intralesional Kenalog injections for fast flare relief, why standard incision and drainage tends to recur, and why deroofing can be such a high-satisfaction option when the same spot keeps flaring. From there, we zoom out to the bigger toolbox: excision for long-standing scar “balls” that no medication can penetrate, plus niche and emerging options like cryoinsufflation, laser hair removal, CO2 laser ablation, photodynamic therapy, IPL, and even Botox for sweat and friction. We also cover real-world constraints that patients and clinicians face, including healing expectations, skin type considerations, and insurance coverage. If you’re trying to build a smarter HS treatment plan or you care for patients with HS and want procedural options you can confidently discuss, listen now. Subscribe, share this with someone who needs it, and leave a review with your biggest HS question. 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.

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.

SPF labels can feel reassuring until you do everything “right” and still end up red, tan, or blotchy. We sit down with board-certified dermatologist Dr. George Martin  to unpack a missing piece in everyday sun protection: visible light and high-energy visible (HEV) light. If you’ve ever wondered what broad spectrum sunscreen truly covers, why UVA and UVB are treated differently, or why pigmentation seems to “break through” even your best routine, this conversation connects the dots with clear, practical skin science. We start by mapping the UV spectrum in plain language: UVB as the classic burning ray tied to skin cancer risk, and UVA as the deeper penetrator linked to photoaging, collagen damage, and wrinkles. Then we move into what most people are not warned about: visible light can drive oxidative stress and free radical damage, and it can strongly worsen hyperpigmentation and melasma. Dr. Martin explains why many sunscreens effectively “stop” around 400 nanometers, leaving a gap where HEV light can still trigger redness and discoloration over long days outside. We also tackle the blue light anxiety around phones and laptops, putting the intensity in context against outdoor sunlight. From there, we dig into what may actually help, including the role of iron oxides in tinted formulas, why concentration matters, and why the industry still lacks standardized testing for visible light protection claims. Finally, we bust a huge myth about shade and indirect UV exposure, plus the simple rules that protect kids and adults better in real-world conditions. If sunburn, dark spots, or premature aging are on your mind, hit play, share this with a friend who never believes sunscreen “fails,” and subscribe for more practical dermatology. After you listen, what’s one sun protection habit you’re ready to change? 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.

In this episode, we talk about the psychology of tanning. I’m joined by Sherry Pogato, a licensed clinical psychologist, professor, and social media researcher at the University of Connecticut, to break down why indoor tanning and outdoor sunbathing can feel so rewarding – and why melanoma risk warnings barely register. We get into the real drivers: appearance motivation, social rewards, stress relief, and the immediate “feel good” effects people report after UV exposure. We also zoom out to tanning culture and access. As laws restrict minors in tanning salons, tanning beds don’t just vanish, they pop up in gyms, off-campus student apartments, and even through systems that let students pay with campus cash cards, creating mixed messages about safety. Sherry shares research showing how simple policy changes can reduce availability, and why “make it less easy to tan” can be more effective than another poster full of statistics. Then we tackle the modern accelerant: social media. From the “natural glow” health halo to TikTok’s visual economy and the rise of "tanmaxing," UV exposure is getting repackaged as wellness and aesthetics. Sherry also explains a promising sun safety intervention that flips the script by recruiting tanners to create and share healthy skin content, shifting behavior through cognitive dissonance instead of preaching. If you care about sun safety, skin cancer prevention, sunscreen habits, or how to change health behavior in a world of algorithms, this one is for you. Subscribe, share with a friend who loves a tan, and leave a review with your biggest question about tanning and UV risk.

“Off-label” can sound like a red flag, but in dermatology it’s often the most practical way to treat real people with real problems. Dr. Trotter sits down with board-certified dermatologist Dr. Victoria Farley to explain what FDA approval actually means, why many effective skin treatments never get a specific label, and how we talk through safety, side effects, and expectations – so patients feel confident rather than confused. We walk through concrete examples you may recognize from your own care: spironolactone for hormonal acne and androgen-related conditions, finasteride and dutasteride considerations for women, and why low-dose oral minoxidil can be a game-changer when topical routines are hard to keep up with. We also cover a classic “wait, why does my prescription mention cancer?” moment with topical 5-FU, and how that same medication can be used off label for stubborn plantar warts with thoughtful counseling and monitoring. From there, we zoom out to what’s next in medical dermatology: GLP-1 drugs and their emerging connection to inflammatory skin disease like psoriasis and hidradenitis suppurativa, plus the rapidly expanding world of JAK inhibitors for immune-mediated conditions including lichen planus, lichen sclerosus, granuloma annulare, and more. We also dig into chronic itch, especially in older adults, and why antihistamines are not always the best long-term answer, with off-label options like naltrexone and gabapentin entering the conversation. If you’ve ever wondered whether off-label prescribing is legal, ethical, or worth it, this conversation gives you a clear framework: evidence, experience, and a patient-specific risk-benefit plan, plus the reality of insurance coverage and prior authorizations. Subscribe for more practical dermatology education, share this with a friend who’s navigating a confusing prescription, and leave a review with the off-label question you want answered 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.

Your hair can feel like a small thing until cancer treatment threatens to take it away. We sit down with board-certified hematologist-oncologist Dr. Tiffany Pompa to talk honestly about chemotherapy hair loss, why it happens, and why the emotional impact is often underestimated by everyone except the people living it. We also dig into how immunotherapy differs, why hair loss is usually uncommon with many immunotherapy regimens in real practice, and where the published numbers can be confusing without context. From there, we get practical about scalp cooling and cold cap therapy: who benefits most, when to start, and what to expect on infusion days. Dr. Pompa explains why taxane chemotherapy such as paclitaxel and docetaxel is a common setting for scalp cooling, especially in breast cancer, gynecologic cancers like ovarian cancer, and lung cancer. We walk through the three FDA-approved systems DigniCap, Paxman, and AMA, including the real-life routine of wearing the cap before, during, and after treatment, plus the most common side effects like headaches, intense cold, and rare frostbite. Access matters as much as science, so we talk insurance coverage, cost, and advocacy. Dr. Pompa shares how she argues medical necessity, why NCCN guidelines help, what Medicare and Medicaid approval in 2026 changes, and how state legislation can expand coverage. We also discuss manual frozen gel cap options like Penguin caps for patients who need a more affordable workaround, along with the tradeoffs. If you or someone you love is starting chemo, this conversation gives you language, options, and a clear next step: ask early. Subscribe, share this with someone who needs it, and leave a review so more patients and clinicians learn that hair loss prevention is part of quality cancer care.

Dark spots can be frustrating, especially when they seem to stick around despite your best efforts. Dr. Heather Woolery-Lloyd joins us to break down what causes hyperpigmentation, the differences between melasma, post-inflammatory hyperpigmentation, and sunspots, and how dermatologists approach treatment. We discuss the role of sunscreen, visible light, hydroquinone alternatives, chemical peels, and evidence-based skincare ingredients that can help fade discoloration. If you're tired of guessing what works, this episode offers a practical roadmap to treating hyperpigmentation more effectively.

You can feel the tension the moment a patient says, “I want that medication.” From SkinTok trends to viral skincare advice, dermatologist Dr. Jim Del Rosso joins us from the AOCD meeting to break down how dermatologists navigate treatment requests while still building trust. We talk about acne, rosacea, topical steroid fears, antibiotic resistance, and why the right diagnosis matters more than chasing internet trends. We also unpack the communication skills that actually improve outcomes, from setting realistic skincare timelines to explaining systemic treatments for eczema in a less intimidating way. If you’ve ever felt overwhelmed by conflicting skincare advice or frustrated that products are not working fast enough, this episode brings the focus back to evidence-based care that actually works.

Chronic hives can hijack your sleep, focus, mood, and confidence, and the hardest part is often not knowing why it’s happening. Board-certified dermatologist and Northwestern associate professor Dr. Walter Liszewski joins us to break down the biggest myths around urticaria, explain the difference between acute and chronic hives, and walk through common patterns like dermatographism, pressure hives, heat-triggered flares, and exercise-induced hives. We also get practical about treatment: when allergy testing actually helps, why Benadryl and steroids are not great long-term solutions, and how newer therapies like omalizumab, dupilumab, and remibrutinib are changing care for people stuck in the chronic hives cycle.