April Martinez-Dulay, MSN, APRN, FNP-BC, Shares Clinical Pearls on Dermatitis and Lymphoma

At the recent DERM 2025 NP PA CME Conference in Las Vegas, Nevada, April Martinez-Dulay, MSN, APRN, FNP-BC, a cosmetic and complex medical dermatology nurse practitioner at Palo Alto Foundation Medical Group, presented sessions on dermatitis and lymphoma. Working closely with Jenny Murase, MD, Martinez-Dulay focuses on caring for highly vulnerable patients suffering from chronic itch and persistent dermatitis.

In her first session, Martinez-Dulay provided clinical pearls on differentiating prurigo nodularis and atopic dermatitis. She emphasized the importance of morphology in diagnosing prurigo nodularis and highlighted three hallmark features of atopic dermatitis: pruritus, eczematous lesions, and a chronic relapsing course. Additional signs include childhood onset and xerosis. She noted that distribution patterns can be diagnostic, such as psoriasis in the gluteal cleft and AD patients who report feeling “allergic to their sweat.” One illustrative case involved a lesion that changed to an “apple jelly” color under a slide test, prompting biopsy and ultimately revealing cutaneous lymphoma. She stressed the importance of re-biopsying resistant dermatitis cases, particularly when patients fail to respond to systemic, topical, or biologic therapies such as dupilumab.

“Don't give up,” Martinez-Dulay advised. “If the patient still continues to have symptoms and does not respond to therapies, then do a biopsy...even if it's 20 times until you get that diagnosis.”

In her discussion on allergic contact dermatitis, Martinez-Dulay reviewed common sites including eyelids, face, hands, and genital areas. She explained the importance of patch testing—the gold standard for allergic contact dermatitis diagnosis—distinguishing between type I (immediate) and type IV (delayed) hypersensitivity reactions. She recommended the American Contact Dermatitis Society website for locating patch-testing providers and emphasized the importance of allergen avoidance, supported by resources like SkinSAFE and American Contact Dermatitis Society tools for identifying safe products.

Looking ahead, Martinez-Dulay expressed enthusiasm for the growing therapeutic arsenal for moderate-to-severe atopic dermatitis, including IL-4, IL-13, and IL-31 inhibitors. She and Murase will continue their work as “the itch and rash whispers” with the Dermatology Education Foundation, providing educational webinars, patient handouts, and clinic tools like soak-and-smear guides.

“We are everybody's best friend, but we are the worst enemy of allergic contact dermatitis, atopic dermatitis, and prurigo nodularis,” Martinez-Dulay said.