Clinical Pearls from the 2025 Fall Clinical PA/NP Meeting: Day 1

Jamie Restivo, MPAS, PA-C, and Lauren Miller, PA-C | Image Credit: Jamie Restivo, MPAS, PA-C

Cultivating the Next Generation: Becoming a Mentor

Lauren Miller, PA-C, and Director of APP Education for Dermsquared, highlighted how mentoring others renews purpose, contributes to career fulfillment, and keeps you sharp. She invited attendees to “leave the ladder down” and called attendees to action.

Time is Your Currency: Productivity Hacks for the PA/NP

Francine Phillips, PA-C, and Dermsquared Advisory Board Member, shared strategies for working efficiently in the clinic while maintaining your well-being. She stressed the importance of preparation to stay on schedule and recommended signing notes every few patients to prevent burnout and end-of-day overwhelm. Phillips also highlighted that not every concern can or should be addressed in a single visit, underscoring the value of setting boundaries and prioritizing self-preservation. After all, you can’t pour from an empty glass.

Social and Smart: Using AI and Social Media to Elevate Your Career in Dermatology

Heather Gates, PA-C, and Dermsquared Advisory Board Member, emphasized the importance of maintaining professionalism on social media while also showing our “human side.” She explained how platforms like Instagram and LinkedIn can be powerful tools for building trust, establishing authority, and boosting patient engagement. Gates also discussed practical ways clinicians can use AI tools like ChatGPT to create patient education materials and craft tailored resumes to help land their dream roles.

A New Era: 2025 Breakthroughs in Atopic Dermatitis (AD)

Cynthia Trickett, PA-C, guided attendees down memory lane to review the major advancements in the AD landscape and offered a glimpse of what’s ahead. She highlighted emerging therapies, including topical pan-JAK inhibitors for chronic hand dermatitis and an expanding pipeline of oral JAK and PDE4 inhibitors. Trickett also underscored the importance of interpreting clinical trials with caution, reminding clinicians that differences in inclusion/exclusion criteria and outcome measures make cross-trial comparisons impossible unless drugs are evaluated in head-to-head studies.

Drug-Induced Skin Disorders

Scott Jackson, MD, FAAD, captivated the audience with his insightful review of drug eruptions, emphasizing that these reactions can take weeks to years to appear and weeks to months to resolve, even after the offending medication is discontinued. He discussed how statins can trigger a range of muscle-related side effects, including autoimmune myopathies like dermatomyositis, and noted that testing for anti-HMGCR antibodies can help to confirm the diagnosis. Jackson also highlighted that medications used intermittently can cause fixed drug eruptions, where re-exposure after discontinuation leads to recurrence secondary to sensitization.

Acne Across All Ages: Treating Pediatric, Adult, and “Hormonal” Acne

Julie Harper, MD, cautioned clinicians to thoroughly evaluate acne in children ages 1 to 7, as it may signal underlying hyperandrogenism. She reinforced that topical treatments, not oral medications, are the true "heavy hitters" in acne therapy, with oral isotretinoin being the exception. For managing acne during pregnancy, Harper introduced her “3 for 3” approach: three topicals including azelaic acid, benzoyl peroxide, and clindamycin, and three oral options, categorized alphabetically: amoxicillin, azithromycin, cephalexin, clindamycin, and erythromycin (excluding the estolate form). She concluded her session with insights on the compatibility of clascoterone when used alongside other topical medications.

Starting the Conversation: Optimizing Psoriatic Disease, Outcomes with GLP-1 Receptor Agonists, a Panel Discussion with Pearl Kwong, MD, PhD, Benjamin Lockshin, MD, FAAD, and Cynthia Trickett, PA-C

The session opened with a deep dive into the connection between psoriasis and obesity. Panelists explained how obesity drives psoriasis severity, fuels systemic inflammation and metabolic dysfunction, and may diminish the efficacy of systemic treatments. They emphasized the bidirectional nature of this relationship; psoriasis increases the risk of obesity, and rising BMI correlates with both greater risk and more severe disease. To support patients, the panel introduced the “5 A’s” approach: Ask permission to discuss weight, assess goals and motivations, advise on evidence-based options, agree on a shared plan, and assist in implementation. The session also featured a detailed review of GLP-1 receptor agonists as part of the treatment paradigm.

Oldies but Goodies: Systemics, When and If to Use

Kristine Kucera, PA-C, and Dermsquared Advisory Board Member, led a comprehensive review of traditional systemic therapies. She discussed the strategic use of methotrexate in combination with biologics, highlighting its ability to enhance antipsoriatic effects, reduce immunogenicity, and support long-term disease control. She did note that methotrexate does not appear to significantly boost ACR efficacy compared to biologic monotherapy. Kucera covered baseline screening, monitoring protocols, side effects, drug interactions, and contraindications for these “old school” therapies. She also shared her approach to prescribing cyclosporine, recommending it as an effective short-term option when rapid clearance is needed. Acitretin was highlighted for its utility in off-label indications such as lichen planus, Darier disease, and lichen sclerosus.

Therapeutic Pearls

Mark Lebwohl, MD, explored the off-label use and strategic optimization of oral hedgehog inhibitors, highlighting their role as neoadjuvant therapy before Mohs surgery and noting that L-carnitine can help alleviate treatment-related muscle spasms. He also shared promising data on short courses of IL-17 inhibitors for guttate psoriasis off-label, which may lead to long-lasting remissions. Lebwohl also reviewed the National Psoriasis Foundation guidelines on the use of biologics in surgical settings and presented findings showing that dupilumab does not impair vaccine-induced immune responses in patients with atopic dermatitis.

When the Patient Isn’t Responding, Now What?

In this session, Cynthia Trickett, PA-C, shared her approach to managing complex atopic dermatitis cases, focusing on common reasons treatments may appear to “fail.” These included misdiagnosis, true lack of efficacy, safety or tolerability concerns causing early discontinuation, poor absorption due to pharmacokinetics, and drug immunogenicity. She highlighted real-world pitfalls, such as a patient microwaving a biologic dose to bring it to room temperature, and emphasized the importance of clear, direct communication. Trickett warned against the “curse of knowledge”, assuming patients understand medical nuances, and reminded clinicians to clarify even seemingly obvious points, like not injecting a biologic meant to treat scalp psoriasis directly into the scalp.

Challenging Pediatric Cases

Adelaide Hebert, MD, provided clinical pearls for diagnosing and managing pediatric and adolescent skin conditions. She explained how examining the lips can help one distinguish staphylococcal scalded skin syndrome (SSSS) from toxic epidermal necrolysis (TEN), with TEN involving the full lips, while SSSS typically affects only the keratinized areas. She highlighted the utility of oral sarecycline for the treatment of acne when photosensitivity is a concern and emphasized the valuable role of combination oral contraceptives in treating acne in females. Hebert also urged clinicians to keep demodex folliculitis in mind for acne-like eruptions, advising providers to: “scrape it out when in doubt.” A gentle bedside scraping with a #15 blade can reveal the mites under microscopy and patients tend to adhere well to treatment once they know demodex is implicated.

How to be an HS Hero

Curtis Chen, PA-C, opened his presentation on hidradenitis suppurativa (HS) by highlighting that the average time to diagnosis is a staggering 10 years. He reviewed various treatment options, including surgical procedures that can be carried out in the office and stressed that compassion and empathy are essential components of effective care for these patients.

Jamie Restivo, MPAS, PA-C, is a board-certified dermatology physician assistant practicing in Enola, Pennsylvania, PA/NP Emerge and LEAP Faculty, and current president of the Pennsylvania Dermatology Physician Assistants (PDPA).