Clinical Pearls from the 2025 Fall Clinical PA/NP Meeting: Day 3

Image Credit: Jamie Restivo, MPAS, PA-C

Psoriatic Disease for the Dermatology Advanced Practice Provider with Lauren Miller, PA-C, Director of APP Education for Dermsquared, and TJ Chao, PA-C, Dermsquared Advisory Board Member

Miller and Chao delivered an in-depth and engaging overview of psoriasis and psoriatic arthritis, covering everything from clinical phenotypes to comorbidities and evolving treatments. They reviewed the full spectrum of psoriasis phenotypes, including plaque, scalp, inverse, guttate, erythrodermic, palmoplantar, pustular, nail involvement, and psoriatic arthritis.

A key focus of this session was the burden of comorbidities. Obesity was emphasized as a major modifiable risk factor that not only increases the likelihood and severity of disease but may also reduce the efficacy of systemic therapies, underscoring the importance of weight management in the comprehensive treatment of these patients. When addressing mental health, Miller encouraged clinicians to ask patients how the disease affects their day-to-day lives rather than just screening for depression and anxiety. This empathetic approach helps destigmatize mental health comorbidities and supports a strong patient-clinician relationship. She tells patients that “it makes sense” that they struggle with anxiety and depression, given how their disease prevents them from engaging in many activities.

Miller and Chao also addressed the social stigma surrounding psoriasis, noting that the public often incorrectly views psoriasis as contagious. They also highlighted how destructive psoriatic arthritis can be, emphasizing that joint damage is irreversible. Miller, a dermatology PA and mom of 2, drew from her clinical experience and experience as a mother, stating that "you can’t unburn the toast.” This drives home the importance of early diagnosis, regular screenings to detect joint involvement, and selecting therapies that treat both skin and joints, as patients get new skin but don’t get new joints.

Chao and Miller advocated for comprehensive skin exams, including the assessment of the nails, scalp, and intertriginous areas, which may reveal hidden or unreported areas of involvement. A thorough exam allows for accurate diagnosis and measurement of body surface area (BSA) affected. This technique also builds rapport and allows the patient to understand that you are taking their disease seriously.

This 2-hour-long session concluded with guidance on managing psoriasis in pregnancy, considerations surrounding biologics and surgery, and a call to action: treat to target, ideally achieving BSA <1%. Chao referred to this era as a “renaissance” in psoriasis care, citing the rapid development of innovative therapies and his optimism for the future. Despite these advancements and more to come, however, they emphasized that most psoriasis patients remain undertreated.

What’s Up and Coming In Aesthetics?

Heather Gates, PA-C, DFAAPA, and Dermsquared Advisory Board Member, delivered an engaging presentation on emerging innovations in aesthetics. Her excitement was palpable as she previewed several novel therapies on the horizon. She introduced trenibotulinumtoxinE as a promising wrinkle relaxer ideal for actors, actresses, and others who need to maintain expressive facial movement, thanks to its fast onset and shorter duration of action. Gates playfully coined it to be “toxin for procrastinators,” noting its appeal to those seeking quick, yet temporary results.

She also highlighted a new hybrid filler combining the benefits of hyaluronic acid (HA) and calcium hydroxylapatite (CaHA), describing it as a “401(k) for your face,” delivering the “instant gratification” afforded by HA alongside the biostimulatory effects of CaHA. The session concluded with an exciting look at a new injectable designed for acne scars, offering immediate volume restoration while promoting elastin production. Clearly, synergistic products are on the horizon for those in aesthetic medicine.

Non-Surgical Nose Jobs

Tanya Patron, PA-C, captivated attendees with her dynamic presentation on the non-surgical rhinoplasty, describing neurotoxin as “training wheels” for dermal filler. Patron emphasized that mastering anatomy is critical when injecting the nose and that safety must be prioritized. She also discussed how combining traditional rhinoplasty with filler-based augmentation of the nose may yield the best clinical outcomes, depending on individual patient goals. Patron reinforced that aesthetic clinicians must be able to recognize and manage potential complications promptly, highlighting the importance of preparedness in every procedure. Risk cannot be obliterated in totality, but rather, greatly reduced with adequate understanding of anatomy and precision in one’s technique.

Real-Ology

Gary Rubin, PA-C, succeeded at turning a highly technical topic on rheology and the properties of dermal filler into an imaginative and thoroughly entertaining discussion. He used seemingly ordinary objects like rock candy, microscopic glass slides, and maple syrup to illustrate the properties of cohesivity, G-prime, crosslinking, and viscosity. To kick things off, he even drew clever parallels between beer ingredients and those found in dermal fillers. He concluded his energetic talk with a call to action, asking attendees to: “believe nothing of what I tell you and only half of what I give you to read,” underscoring the importance of always remaining inquisitive in the practice of medicine.

Neuromodulator Complications

Gates took to the stage once more to present on neuromodulator complications. She initiated her discussion by sharing a personal episode in which she suffered from lip ptosis at an inopportune time and what she did to mitigate this, along with taking it in stride. Gates reviewed a case of anisocoria that was indeed attributable to neurotoxin and another that led to the surprising discovery of a pituitary tumor. One key takeaway was to “trust one’s spidey senses” and lean into your medical training because even in aesthetics, clinical acumen and instincts matter.

Pretty Perspectives, Aesthetic Experts Unfiltered, Real Talk, Bold Takes, and No Filter with Gary Rubin, PA-C, Heather Gates, PA-C, and Tanya Patron, PA-C

In this session, experts shared their insights on best practices for social media in aesthetics and advocated for “collaboration over competition” in oversaturated markets. Rubin, Gates, and Patron established that treating your patients responsibly and achieving a natural, restored aesthetic ultimately leads to long-term profitability as opposed to choosing strategies that prioritize more product and maximizing sales at all costs.

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).