Internal Drivers of Skin Disease

This set of lectures examines the systemic, inflammatory, neuroimmune, endocrine, and psychosocial factors that shape dermatologic disease. Topics include metabolic dysfunction, obesity, insulin resistance, hormonal and thyroid disorders, the brain-skin axis, psychodermatology, mast cell activation, and chronic inflammatory conditions. Learners will also explore evidence-based approaches to topical steroid stewardship, culturally competent diagnosis in skin of color, and the integration of pharmacologic, lifestyle, behavioral, and complementary strategies into individualized dermatologic care.

Intersection of Metabolic Health and Dermatology: Impacts on Skin and Hair - (Apple Bodemer, MD)

Metabolic health can influence inflammatory pathways that contribute to dermatologic disease. This session explores how metabolic dysfunction, obesity, and insulin resistance affect skin and hair, including the role of androgenetic alopecia and the clinical implications of HOMA-IR screening. Additionally, the session will review how GLP-1 agonists impact dermatologic and hair outcomes, providing practical strategies for patient management.

Learning Objectives:

After completing this session, participants will be able to:

• Describe the relationship between metabolic dysfunction and inflammatory dermatologic disease.
• Evaluate how obesity and insulin resistance influence skin and hair outcomes, including androgenetic alopecia.
• Apply strategies for recognizing metabolic contributors and the clinical use of HOMA-IR screening.
• Assess the impact of GLP-1 agonists on dermatologic and hair health and integrate this knowledge into patient care.

Cutaneous Manifestation of Endocrine Disorders: Thyroid, Androgen, Insulin - (Ganary Dabiri, MD PhD)

This session will explore how endocrine disorders such as thyroid dysfunction, androgen excess, and insulin resistance manifest in the skin. The lecture will cover clinical presentation, underlying mechanisms, and how hormonal imbalances and obesity influence dermatologic conditions. Attendees will gain practical insights into recognizing and managing cutaneous signs of systemic endocrine disorders.

Learning Objectives:

After completing this session, participants will be able to:

• Identify common cutaneous manifestations associated with thyroid, androgen, and insulin-related disorders.
• Explain the connection between hormonal imbalance, insulin resistance, obesity, and skin health.
• Apply strategies to integrate endocrine assessment into dermatologic practice.

The Brain-Skin Axis: A Systems-Based Approach to Neuroimmune Signaling in Chronic Dermatologic Disease - (Angela Mazza, DO, ABAARM, FAAMFM, ECNU)

Chronic inflammatory skin diseases often persist despite appropriate dermatologic treatment, suggesting the involvement of broader neuroimmune, neuroendocrine, metabolic, and lifestyle-related factors. This session explores the bidirectional communication between the nervous, endocrine, immune, and integumentary systems and its role in inflammation, itch, barrier dysfunction, and disease persistence. Attendees will examine the impact of stress physiology, autonomic dysfunction, hormonal changes, metabolic health, mitochondrial function, and the gut-skin-brain axis on dermatologic disease activity. Through a systems-based clinical framework, participants will learn practical strategies for recognizing contributors to chronic inflammation and integrating comprehensive approaches to patient care.

Learning Objectives:

After completing this session, participants will be able to:

• Describe the neuroimmune and neuroendocrine pathways involved in chronic inflammatory skin disease and their impact on inflammation, itch signaling, and barrier function.
• Identify the role of stress physiology, HPA-axis dysfunction, autonomic imbalance, and systemic contributors in the persistence of chronic dermatologic conditions.
• Apply a systems-based clinical framework to identify and address neuroimmune, metabolic, hormonal, and lifestyle factors that may influence disease activity and treatment outcomes in patients with chronic skin disease.

Psychodermatology: The Brain-Skin Axis in Clinical Practice - (Diana Hurwitz, MD)

Psychological distress and chronic inflammatory skin disease are linked through complex neuroimmune pathways that influence disease activity, treatment outcomes, and quality of life. This session will explore the biologic mechanisms underlying the brain-skin axis, including the role of inflammatory cytokines, stress physiology, neuroendocrine signaling, and the gut-skin-brain connection. Attendees will review practical approaches to psychosocial screening in dermatology, evaluate emerging evidence for immune-modulating therapies and psychodermatologic interventions, and discuss strategies for integrating multidisciplinary care into clinical practice.

Learning Objectives:

After completing this session, participants will be able to:

• Define psychodermatology and classify dermatologic conditions by their psychodermatologic category
• Identify the shared neuroimmune pathways linking skin inflammation and psychiatric comorbidity
• Apply a structured psychosocial screening approach to patients with chronic skin disease

Steroids: Friend or Foe? - (Peter Lio, MD)

Topical corticosteroids (TCS) remain the cornerstone of inflammatory skin disease management, yet their misuse, overuse, and under-education have contributed to patient harm, fear, and controversy, including the growing discourse around topical steroid withdrawal (TSW). This session will examine where topical steroids clearly help, where they can cause problems, and how miscommunication has fueled both under- and over-treatment. Attendees will gain a practical framework for steroid stewardship, including appropriate selection, dosing, duration, and monitoring. The session will also address TSW: what is known, what remains controversial, and how clinicians can counsel patients thoughtfully and responsibly.

Learning Objectives:

After completing this session, participants will be able to:

• Differentiate appropriate versus inappropriate use of topical corticosteroids based on potency, anatomic site, patient age, and disease severity.
• Apply principles of steroid stewardship to minimize adverse effects while maintaining effective disease control.
• Identify clinical patterns and patient narratives commonly associated with topical steroid withdrawal and distinguish them from poorly controlled dermatoses.
• Counsel patients using evidence-based, empathetic communication strategies to address fears, expectations, and misinformation surrounding topical steroids and TSW.
• Apply non-steroidal and adjunctive therapies into long-term management plans to reduce reliance on topical corticosteroids when appropriate.

Dermatologic Diagnosis in Skin of Color: Clinical and Cultural Considerations - (Lakshi Aldredge, NP)

This session highlights the importance of understanding Skin of color presents unique clinical variations that can impact diagnosis, management, and patient outcomes. This session highlights the importance of understanding these differences and recognizing how common dermatologic conditions may appear differently across diverse skin types.

Participants will review variations in clinical presentation, explore cultural practices that may mimic or influence skin conditions, and develop practical approaches to improve diagnostic accuracy. The session also emphasizes culturally competent care, equipping clinicians with strategies to better evaluate and manage patients with skin of color in everyday practice.

Learning Objectives:

After completing this session, participants will be able to:

• Identify why learning about Skin of Color is important
• Identify different clinical presentations of common skin disorders in skin of color
• Identify several cultural practices that may present as skin conditions
• Identify methodologies to be culturally competent when evaluating skin conditions in skin of color patients

Mast Cell Activation Syndrome (MCAS) - (Sonal Choudhary, MD)

Mast Cell Activation Syndrome (MCAS) is an underrecognized, multisystem condition that frequently presents with dermatologic manifestations such as chronic urticaria, flushing, pruritus, and angioedema. This session provides dermatologists with a practical, clinic-ready framework to identify, diagnose, and manage MCAS.

Participants will review mast cell biology, consensus diagnostic criteria, and key clinical patterns that differentiate MCAS from common dermatologic conditions. The session also highlights systemic associations, appropriate laboratory evaluation, and an integrative treatment approach that includes pharmacologic therapies, lifestyle interventions, and patient-centered care strategies.

Through case-based learning and clinical pearls, attendees will gain actionable tools to improve recognition, avoid misdiagnosis, and optimize outcomes for patients with complex, multisystem presentations.

Learning Objectives:

• Identify key dermatologic and systemic clinical features suggestive of mast cell activation syndrome
• Apply consensus diagnostic criteria and appropriate laboratory workup in patients with suspected MCAS
• Differentiate MCAS from common dermatologic conditions such as chronic urticaria, rosacea, and angioedema
• Develop a stepwise, integrative treatment plan that includes pharmacologic therapies, trigger management, and lifestyle interventions
• Identify associated conditions, including POTS and hypermobile Ehlers-Danlos syndrome, in patients with suspected MCAS