15-05-2025
S3 Episode 4: What's New in Psoriasis? Dermasphere Podcasters Weigh In
This transcript has been edited for clarity. For more episodes, download the Medscape app or subscribe to the podcast on Apple Podcasts, Spotify, or your preferred podcast provider.
Steven R. Feldman, MD, PhD: Hello. I'm Dr Steve Feldman. Welcome to Medscape's InDiscussion series on psoriasis. And welcome to this very special episode where we're joined by the dynamic duo behind the best place to get dermatologic information, Dermasphere . It's so good. It's so efficient, it's so entertaining. Our guests are Dr Luke Johnson and Dr Michelle Tarbox. Dr Johnson is an associate professor of dermatology at the University of Utah, and Dr Tarbox is a professor of dermatology at Texas Tech University Health Sciences Center. Together, they built Dermasphere into a go-to resource for dermatology professionals, blending clinical insights with evidence-based discussion.
Today, we're flipping the script, interviewing them about what's new in dermatology, focusing on psoriasis in 2025 and their predictions for the future of the field. Welcome to InDiscussion .
Luke Johnson, MD: Super excited to be here.
Michelle Tarbox, MD: Thank you so much for having us.
Feldman: Michelle, Luke, how did you two get together?
Tarbox: I was lucky enough to get to train Luke. I came to Texas Tech University in beautiful, sunny Lubbock, Texas, in 2013. I moved there because my parents lived in Lubbock and had some health needs. They needed a dermatologist in the program at Texas Tech, and sometimes God just tells you what to do.
I needed to get home to my parents. I needed to be closer to my mom and dad, and I got to have the great honor of helping to take care of my mom as she dealt with, unfortunately, Alzheimer's, which she passed from in December. But I got to have 11 wonderful years getting to be by her side and help her with that.
And as part of that process, I jumped into the residency program at Texas Tech. Now, I did not get to be part of selecting Dr Luke Johnson for residency, but I like to think he would've been one of my first choices for his residency class because he was an absolutely fantastic resident.
Johnson: I don't know about being a fantastic resident, but the rest of it checks out.
Feldman: How did you get started in podcasting?
Johnson: When I joined the faculty at the University of Utah, there was a group of faculty that were doing innovative things with technology and with ideas, and I thought that looked like a cool thing to be a part of. So I asked if I could be a part of it and they said, "Sure. It might help if you have a particular project or idea that you want to explore while you're part of us."
When I was a resident, I wanted there to be a dermatology podcast out there with updates from the literature so I wouldn't have to try to read them; I could just listen to what somebody else thought was worth listening to while I was exercising or driving. And back then there were not a lot of options.
There are a lot more dermatology podcasts now. I said, "What if I make that?" And they said, "That sounds good." And then I immediately thought of Michelle Tarbox as the ideal co-host. To my continued surprise, she said yes, despite everything else that she has going on in her life. And we've been rolling along for the past 5 years or so.
Feldman: Did you start with a physician-focused program or a patient podcast at the same time?
Johnson: We started with a podcast by dermatologists, for dermatologists, and for the dermatologically curious. About a year or two into it, some of the folks at the University of Utah asked if we wanted to make a podcast intended for patients as well, and so we said, "Sure. We know how to make podcasts. That sounds fun." And so we had a podcast called Skincast for a time. And then it ended up being a heavier lift than I thought it would be. We kind of picked all the low-hanging fruit and talked about acne and warts and molluscum and eczema and stuff. And then we were like, okay, well what else is there?
We already had a lot of time devoted to Dermasphere . It's a labor of love, and I decided I didn't have time for another of those labors, and so Skincast went by the wayside. The podcast episodes are still out there, I think, and I think we had some good discussions on them. Currently we're focused on our podcast for other healthcare providers.
Feldman: I get to travel a lot, speak to a lot of dermatologists, and everywhere I go they invariably tell me, "I heard you on Dermasphere ." Do you have any sense of how big Dermasphere is?
Johnson: There are metrics. An average episode these days gets about 3000 listens throughout its "lifetime," which is small compared to something like Freakonomics or the NPR podcasts. But it's big when you think about how many people are listening to you in an average talk that you give to other dermatologists.
I think that's pretty good. And we've been listened to in, like, 110 countries. You can track all this stuff; it's kind of fun to look at.
Feldman: Does your promotion committee at your university appreciate the impact that you're having?
Tarbox: I'm very fortunate at Texas Tech. They heavily value education and they heavily value devotion to improving access. And there has been appreciation from my institution about both the teaching impact as well as improving access to dermatologic expertise and information through the podcast.
Because our listenership is largely dermatologists, dermatology residents, we have a lot of allied health professionals who listen and dermatologically interested medical students, as well as some of our partners in industry. And we can disseminate important information like potentially important drug interactions to be aware of.
Sometimes these are things that the interaction checker for major EHRs doesn't catch. Getting that information out into the listenership can potentially help prevent a fatal side effect. I think that can be significant. But it's also fun. We can build community, we can learn together.
We were approached at one of the AAD meetings we were speaking at together in the Resident Jeopardy! session by a group of military dermatologists, and they expressed their gratitude for the podcast's existence because they practice in isolation. They don't have a large group that they're with, and through the podcast they listen and use it as sort of a discussion tool, and they build community through it.
And that's the end goal. When Luke and I started doing this, we were recording in our closets with blankets over our heads, trying to figure out how to deal with the acoustics. I was positive that the only people listening were Luke, myself, and my dad. I was like, "We've got three listeners, Luke, but at least we're learning something."
I'm very appreciative of how the podcast has grown, that people listen, and that it helps them keep up with the dermatologic literature.
Johnson: The University of Utah is very forward-thinking about this stuff as well. They certainly appreciate that we're doing this work.
Feldman: That's awesome. Well, over the past 25 years, I think it's safe to say that most of the interesting things that have been happening in the world of dermatology have been related to psoriasis. And it doesn't seem to be slowing down; it seems to be accelerating over time.
You must have covered some interesting things about psoriasis. Tell me about it.
Johnson: We try to make an effort to discuss the trials that get new drugs approved, and so we've talked about a lot of our new fancy psoriasis medications. We're ( Dermasphere podcast) not sponsored by any of them, but I'll say, based on the data that I've reviewed, they're all pretty great. My current favorite is bimekizumab. It seems to have higher efficacy than the others in the same space, and importantly, bimekizumab doesn't seem to be any more expensive than the others.
We've discussed in this the potential association of IL-17 inhibitors — bimekizumab and IL-17 — with inflammatory bowel disease (IBD). [In an article from a few years ago,] there was a picture of a diseased colon that was resected from somebody — not something we usually see in the dermatology literature. As long as you screen your patients, make sure there's no personal or family history or concerning symptoms of IBD, that tends to be the one I use.
Tarbox: We've covered psoriasis as a disease state in over 20 episodes. I think we've reviewed over 22 articles discussing psoriasis as a disease state.
One of the most interesting ones was looking at the exposure to the Western diet and the potential inducement of psoriasiform dermatitis through causing inflammation on the IL-17 axis. They did find that the Western diet, when fed to mice, increased inflammation in the IL-17 axis and was able to induce skin inflammation analogous to psoriasis.
There was another interesting article we looked at, about dietary supplements and potentially therapeutically using those to mitigate psoriasis. The gut-skin axis is something that's very interesting in the field, and we see that a lot with many of the therapeutics, sharing therapeutic efficacy across IBD and psoriasis.
And then there's this question of IBD activation through IL-17 inhibition. It highlights the fact that the immune system is very delicate in its balance and there are a lot of feedback loops; understanding those can help us pick the right therapies for patients. Just like Luke was saying, proper patient screening is key.
There are certainly things that you want to think about whenever you're visiting with a patient who has psoriasis for the first time, to try to pick a therapeutic for them, or if you're choosing a new therapeutic because they've had treatment failure or a side effect — really delving into their family history, their personal history, their lifestyle, and trying to find the best fit.
We are in a wonderful period as dermatologists and doctors who treat psoriasis in that we have a wealth of options now. We used to have only phototherapy. As a dermatologist named Tarbox, I have to bring up Goeckerman — the fact that we would bring people into a hospital, put tar on them, and then put them in a light box.
There are these options now that are much more convenient for patients, much more accessible for patients, and can be tailored to the individual person, their medical history and their lifestyle. That's a really wonderful space to be in.
What are your practice pearls for psoriasis?
Feldman: When I'm trying to organize the structure of presenting information on psoriasis, I think about starting with disease state and quality-of-life stuff first, and maybe comorbidities management, and then topicals, then systemics. You brought up disease state.
It's cool that we know this IL-23, TYK-2, IL-17 axis. Before I got to Wake Forest, the psoriasis specialist here was the fabulous Michael Zanolli. He and Joe Jorizzo started a Goeckerman Center here at Wake Forest. Wake Forest also has a big primate colony where they do cardiovascular research.
One of the monkeys in the high-stress Western diet arm of their study developed psoriasis. This is a primate model of psoriasis that they had. I don't think you've covered this article because they probably wrote it before you were born. It was limited psoriasis, and Jorizzo, I think, thought, Well, we have to make this worse. I'll just give him some steroids, withdraw the steroids, and cause a flare. And they cured this one primate model of psoriasis.
The psoriasis went, but they also took that animal out of the high-stress environment from the colony that it was in because the rash maybe had something to do with it.
Johnson: We've talked about a few oldies, we've talked about one from West Berlin, remember that? That was, like, back in the 1970s. We've talked about a couple articles that discussed whether you can address psoriasis to some degree by addressing diet and supplements. And some of the authors make a fairly decent case that at least in some patients, something like that could be helpful, but it requires significant lifestyle changes and diligent adherence. It made me think about a theme that's come up throughout the podcast, which is that some of our diseases, like psoriasis and atopic dermatitis, that we call different names, are probably some kind of final common pathway.
Seems like there are different ways to the IL-17, IL-23 TYK stuff. And perhaps in different patients, addressing it in different upstream measures could be more or less effective.
Feldman: I think that's right. The bulk of people who have psoriasis have relatively limited disease. I'm not saying "patients" but that the bulk of humans in the population that have psoriasis have limited disease, and they just need topicals. Have you covered interesting developments in the world of topical treatment of psoriasis?
Tarbox: This is an era that has some topicals that rival the efficacy of some of our earliest biologics. I've been very impressed with the development of roflumilast and tapinarof.
The efficacy of these topicals, especially in focused or limited psoriasis, can be quite astonishing. I've had some patients that are just not ready for a systemic agent, from their own personal perspective. They don't want to take a medication by mouth or an injection, but they have some pretty significant plaque psoriasis and have really been impressed with the efficaciousness of these newer therapeutics.
I know access is something that you have to navigate because they are newer therapeutics, and both of the companies that make those topicals do have pretty robust patient support programs. So, we've been able to get a lot of patients on those medications.
Patients tend to tolerate them well. I do notice that there is a greater concern from patients in general about using topical corticosteroids, which are still a workhorse of our practice. Are you encountering this, Dr Feldman, where patients come in ready to say no to anything that's a topical steroid?
Feldman: No, but that's perhaps because I never used the word "steroid" in front of a patient.
Johnson: "A cortisone-type medicine."
Tarbox: You have to meet people where they are.
Feldman: I prescribe a lot of topical steroids and I would've thought that if you gave them clobetasol and it didn't work, it was probably because they didn't use it. And therefore, if you give them a different topical, they wouldn't use that either. I think you're seeing a lot of success. You must be doing a great job getting people to put that stuff on.
We've discussed topical development. How about in the systemics? We mentioned bimekizumab, and there have been other biologics as well, including some JAK inhibitors that are now approved for psoriasis, like deucravacitinib. And then there are more in the pipeline, so I'm sure you guys have discussed what are you excited about.
Johnson: I honestly don't pay that much attention to stuff in the pipeline because some of it never gets out of the pipeline.
And then I've wasted my time, perhaps, or at least used it inefficiently, in trying to learn about these things that might not ever be available. But I've heard some buzz about an oral IL-17 inhibitor, and I think that's intriguing because some people really don't want shots, and the IL-17 inhibitors work well.
Feldman: Have you heard about the oral IL-23? The one thing about the oral IL-17 that makes me a little nervous is that it may increase your risk of yeast infection. I mean, if you're born without IL-17, you get chronic mucocutaneous candidiasis. But I think about that IBD risk, and here you'd be given it orally, so it'd be going right to the bowel. Would there be more IBD risk? And you know what? The immune system's inscrutable. I have no idea whether there will be or not. We'll have to see. But an oral IL 23, especially if they have a component of IBD along with their psoriasis, because all that psoriasis, psoriatic arthritis and IBD — all the genes from that IL-23, TYK-2, IL-17 axis are related.
Tarbox: And some of the articles we've covered are about ways to use the medicine that are a little different from paradigm. One article we looked at talked about treating guttate psoriasis. I think we've all treated patients who are children who had an upper respiratory infection and they come in with guttate psoriasis acutely. We have a good feeling that this is going be a time-limited event for this patient. When they develop it as an adult, you get a little bit more nervous. The article discussed treating guttate psoriasis with systemic medications, specifically IL-23s or IL-17, because you may have a window of opportunity to prevent chronicity and disease in a patient who has a presentation that's kind of outside of that typical childhood presentation after an upper respiratory infection.
And they talk about some of the memory pathways that get implicated in established psoriasis vulgaris, like the Langerhans cells and the tissue resident memory cells, which can sort of sustain disease memory and are the reason why the condition can keep recurring in the same place. We're talking a lot about these tissue resident memory cells as well in conditions like alopecia areata; they're one of the reasons that a condition can keep homing to the same place.
I wonder whether we wouldn't find the same population of cells in things like fixed drug eruption, where patients get the eruption in the same place every time on re-presentation of the drug. I think making these connections across these disease states as we start to understand the way the immune system talks to itself is going to be the forefront.
One of the best uses of AI technology as we move into this brave new world is going to be realistic 3D modeling of an intercellular-like environment. When we look at these pathways, we're used to them being presented in 2D, where we have our transmembrane receptor and then our downstream signaling. But the fact of the matter is, none of these things are happening in isolation, right? These messengers and these cytokines and these conformational changes are all happening packed up against other cytokines and confirmational changes in proteins. How do those things affect each other in a real-cell environment?
My hope is that alongside using AI to make witty memes and cute mockups of what you would look like as a Barbie, we could potentially use it as well to model the intercellular environment and understand inside the cell how these different pathways affect each other. It's not possible that they don't.
Feldman: Before I let you go, is there anything you would tell your listeners about how you expect Dermasphere to evolve?
Tarbox: Ooh. We are trying to build some resources for our listeners. A lot of our listeners are people in training or people who are aspiring to train in dermatology, and so we're working on building resources about how to start doing research, how to write your first case report, how to conduct a systematic review, how to do a meta-analysis.
There are resources out there, of course, that live on the web. But I think that having them in a place where people can find them easily, and maybe having them tailored a little bit more specifically to the world of dermatology, would be useful, adding advice for people trying to pursue dermatology residency.
I've realized as I've given talks at different institutions, as well as at different meetings, that there's an unmet need for students who don't have a home derm program, to have some mentorship in how to navigate the dermatology Match. And so I have a little project that I call the No Drama Derm Mama.
The point of it is to help people who don't have access to a local mentor navigate the somewhat challenging and ever more difficult process of attacking the dermatology match because it is a very competitive specialty. Every year we have great candidates who go unmatched. Trying to find ways to help improve the odds of these good people to find a spot in our specialty, I think, is an important thing. Luke, any other things?
Johnson: I often think to myself, should Dermasphere try to evolve into a larger platform space? Should we have educational videos? Should we have things that target residents specifically? Should we have more stuff for the general population? And then I think, yeah, maybe that sounds kind of cool. And then I fall back into the stuff that I always do.
You need time and other resources. I think about that sometimes; maybe it'll happen. That'd be fun.
Feldman: Awesome. Today we've had doctors Luke Johnson and Michelle Tarbox talking about the future of psoriasis treatment. A couple key takeaways of this episode are the advances we've had in topical therapy for psoriasis and the advances we've had in systemic treatments, but most importantly, the advances we've had in how to learn about dermatology.
Dermasphere is an awesome podcast. I'd strongly encourage you to take a listen. Thank you all so much for joining us. This is Dr Steve Feldman for InDiscussion .
Listen to additional seasons of this podcast.
Dermasphere - The Derm Podcast
Skincast
Bimekizumab in Patients With Psoriatic Arthritis, Naive to Biologic Treatment: A Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial (BE OPTIMAL)
Inflammatory Bowel Disease Induced by Bimekizumab
Short-Term Exposure to a Western Diet Induces Psoriasiform Dermatitis by Promoting Accumulation of IL-17A-Producing γδ T Cells
Dietary Intervention and Supplements in the Management of Psoriasis: Current Perspectives
The Patient's Guide to Psoriasis Treatment. Part 4: Goeckerman Therapy
Deucravacitinib Versus Placebo and Apremilast in Moderate to Severe Plaque Psoriasis: Efficacy and Safety Results From the 52-Week, Randomized, Double-Blinded, Placebo-Controlled Phase 3 POETYK PSO-1 Trial
Emerging Oral Therapies for the Treatment of Psoriasis: A Review of Pipeline Agents
Callus and Its Keratin Before and After Treatment With Acid Sodium Thioglycolate. A Study by Scanning and Conventional Electron Microscopy
