Christina Lam, MD: Overcoming Challenging Cases in Dermatology

Every now and then, clinicians are faced with a case that truly stumps them. Often, the patient does not respond in an expected way to a routine treatment, or perhaps their disease runs a rogue course. These situations can be confounding, but there are some pearls to lean on and pitfalls to avoid.

Christina Lam, MD, assistant professor in the department of dermatology at Boston University Chobanian & Avedisian School of Medicine in Boston, Massachusetts, and colleagues will gather at the American Academy of Dermatology (AAD) 2023 Annual Meeting, held March 17-21, in New Orleans, Louisiana, for a panel on complex medical dermatology cases, including dermatomyositis, hidradenitis suppurativa, atopic dermatitis, and more.

This transcript has been edited for clarity and length.

Dermatology Times: You will be directing a session at AAD on “Complex Medical Cases.” Why should your colleagues attend this session?

Lam: That's a very good question. We see a lot in dermatology, I think, complex medical dermatology cases that encompass a wide variety of diseases. In this session, what we did was pick certain things that dermatologists in general have questions about in terms of management and in terms of diagnosis, and we tried to make it really practical using a case-based approach that physicians would see very commonly, and then using tips and tricks and pearls from the dermatologist’s experiences, talking about those cases and how they would approach them. We'll have cases on dermatomyositis. We'll also have cases on hidradenitis suppurativa, where there's been a lot of new developments in the recent couple of years. Also, cases on vasculitis, lupus, and then atopic dermatitis, particularly in a pediatric population.

Dermatology Times: Can you preview some of the practical pearls for treating patients with complex cases?

Lam: I think an overarching tip that comes up a lot in these more complex cases, especially, is if something doesn't respond the way we kind of expect it to, or doesn't fit the picture, in general, [and] the clinical presentation, then it's worth it to dig a little bit deeper, whether it's by doing extra biopsies or extra tests, or maybe completely changing your diagnosis around and trying a different therapeutic option. These diseases, sometimes there's overlap, sometimes they present a particular way and then after a little while, they change the way that they present a little bit. I think it's important to keep that in mind that if you're stumbling and things just don't work the way you expect them to, [then] change course; it's never too late to do that.

Dermatology Times: Can you provide a brief overview of some of the novel diagnostics covered in the session?

Lam: There are some, in particular, the hidradenitis suppurativa (HS) session…there are more commercially available antidrug antibodies now, specifically for adalimumab, which is an FDA-approved drug for HS. There is some literature looking at how we can use drug levels and antidrug antibodies to manage these patients, particularly when the disease doesn't respond the way we expect it to. Is it because they've developed antibodies? Do we need to do something about it? Can we change their medications around, add something, or perhaps just change biologics completely? That's 1 thing in the hidradenitis suppurativa lecture that will be addressed.

In the dermatomyositis lecture, there is probably in the last few years quite a bit of research being done on very specific myositis antibodies that have changed the landscape, really, of how we treat dermatomyositis. Before we didn't used to know, and so patients would present with different phenotypes, certain skin findings, maybe more or less chance of having pulmonary disease or malignancy associated with it, and we didn't always know why. There's been a lot of research looking at, “Can we phenotype patients based on these very specific antibody profiles?” You can send out to very specific labs now, looking at these very specific myositis antibodies, and that can help you a little bit with the patient's presentation. Are they more or less at risk for developing malignancy? Are they more or less at risk for developing pulmonary disease and, also, [we] can help a little bit in terms of prognosis. For the patients that can be very helpful [to know] whether or not their disease will progress very quickly and be very bad, or perhaps it'll be a milder course. It's something we can kind of reassure them, so that's definitely helped a lot in terms of the way we can counsel our patients.

I think it's going to be a very interesting session. We have a great group of speakers lined up. I hope that people will attend. I think we're very open to questions, as well. In the past when we've done this session, we'd had very nice questions from the audience and a lot of interactive feedback, as well, from the audience in terms of questions that they might have or cases that they've seen that they wanted to get some advice on or things like that so I hope people will come.

The AAD session, “Complex Medical Cases: Pearls and Pitfalls,” will be held Saturday, March 18, 2023, from 1:00-3:00 PM CDT in New Orleans Theater A.

Sign up here to receive e-Newsletters from Dermatology Times, including news and updates from the meeting.

Faculty Disclosures: Dr Lam reports a consultancy with Biogen.