Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1

As you look at the SARS-CoV-2’s ability to remain airborne consider door handles harboring the virus for 2 days, tight quarters (elevators) and small rooms where a sneeze could leave virus aerosolized for hours.

HCQ vs chloroquine in vitro activity against SARS-CoV-2 and rationale for using HCQ in COVID19 confirmed cases.

The results of this in-vitro cell culture experiment suggest that hydroxychloroquine works better at inhibiting SARS-CoV-2 than chloroquine.

Combined therapy using HCQ + azithromycin results in viral clearance in COVID19 infections

Although it was a small study, HCQ when dosed at 200 mg TID x 10 days results in significant clearance of the SARS-CoV-2 viral load in the nasopharynx of COVID-19 patients compared to non-treated controls.


Infectious Disease: Maui Derm 2019 Highlights

Matthew Zirwas, MD

In this session, Matt J. Zirwas, MD discussed the challenges of managing a range of contact dermatitis dilemmas, including:

  • When to patch test and when to treat empirically
  • Non-allergenic topicals
  • Low allergenicity personal care products
  • Allergen updates
  • The explosion of contact dermatitis from essential oils
  • Fragrances
  • Change in which formaldehyde releasers are most common
  • New or up-and-coming allergens, including long lasting nail polish, glucosides, and ammonium persulfate
  • Effects of L-histidine supplementation in atopic dermatitis
  • Oral management of xerotic dermatitis


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Infectious Disease: Maui Derm 2019 Highlights

Ted Rosen, MD

Ted Rosen, MD

Session moderator Ted Rosen, MD provided a thorough overview of the latest in infectious disease. Dr. Rosen discussed the arbovirus threat in the United States, including chikungunya and zika. Dr. Rosen also mentioned ongoing research on the potential oncolytic effects of the zika virus for neuroblastoma and glioblastoma. Yellow fever outbreak in Brazil and West Nile Virus in the US was reviewed, as well as the rising incidence of syphilis gonorrhea in the US. Dr. Rosen discussed his own research on ozenoxacin cream for the treatment of adult and pediatric patients with impetigo. Other research on 15% and 10% potassium hydroxide for Molluscum contagiosum was also reviewed. Other topics discussed include the possibility of a two-drug regimen for stable HIV, evidence for oral antibiotic exposure and increased risk of kidney disease, E. coli resistance to antibiotics after exposure to fluoxetine, tecovirimat for smallpox, leptospirosis associated with contaminated water from floods and the use of chemoprophylaxis after floods to reduce outbreaks, antibiotic links to increased risk of death in heart disease patients and cancer relapse, and hypoglycemia in patients taking fluoroquinolone.

Dr. Sheila Fallon-Friedlander

Dr. Sheila Fallon-Friedlander

Sheila Fallon-Friedlander, MD discussed infectious disease in pediatric patients.
Dr. Fallon-Friedlander discussed many cases and topics, including:
  • Invasive mold disease in immunocompromised children
  • Eczema herpeticum
  • A study showing a lack of significant efficacy of cyclosporine in pediatric cases of Stevens–Johnson syndrome/toxic epidermal necrolysis.
  • The case of a three-day-old boy with diffuse superficial skin erosions and brown crusts on the back
  • Perianal pseudoverrucous papules and nodules
  • Ivermectin and permethrin for treating scabies
Dr. Aditya K Gupta

Dr. Aditya K Gupta

Aditya K. Gupta, MD, PhD, FAAD, FRCP (C) provided attendees with updates on onychomycosis and tinea. Regarding onychomycosis epidemiology, Dr. Gupta addressed the role of the immune system in conferring protection or susceptibility to dermatophyte infections, the increased risk of Candida or Aspergillus onychomycosis in elderly individuals or those with renal transplants, HIV, or diabetes, and the increasing prevalence of onychomycosis. Dr. Gupta also compared diagnostic strategies and reviewed strain typing for onychomycosis. In addition, Dr. Gupta reviewed optimal regimens for oral drugs such as terbinafine, itraconazole, and fluconazole. He also discussed research on posaconazole and albaconazole. Topical therapies including ciclopirox 8% HPCH nail lacquer, efinaconazole, and tavaborole were reviewed. In addition, Dr. Gupta discussed a critical review of laser studies. Dr. Gupta finished his presentation with strategies to prevent onychomycosis recurrence and learning objectives for the future.

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Cosmeceuticals: Maui Derm 2019 Highlights

In this session, three of the world’s leading authorities in the cosmeceutical arena, Drs. Carl Thornfeldt and Henry Lim discussed the latest innovations in technology and product development in the field of cosmeceuticals.
Carl Thornfeldt, MD FAAD, RSM, educated attendees on selecting the best cosmeceutical, with an emphasis on herbs. Dr. Thornfeldt’s presentation covered such topics as:
  • The many conditions associated with destructive chronic inflammation and disrupted skin barrier
  • In vitro data as an inadequate method for predicting human success
  • The requirements for “active ingredients” to remain effective at varying concentrations and formulations, and methods for determining whether these ingredients actually work
  • Dermatopharmacokinetics
  • Manufacturing and packaging specifics to protect ingredient efficacy
  • Precedents for ensuring cosmeceutical efficacy and safety
  • The benefits of using herbs in cosmeceuticals
  • The effects on climatic and seasonal conditions, time of harvest, storage site and duration, and extraction method on the active ingredients in herbal extracts
  • Results from studies comparing herbal blends with prescription products for the treatment photoaging and eczema
Henry W. Lim, MD

Henry W. Lim, MD

Henry W. Lim, MD used his presentation to discuss the latest in photoprotection. He began with the results of a survey on photoprotective habits including using sunscreen, seeking shade, and wearing hats and other protective clothing. Survey respondents who reported engaging in all four habits showed the lowest likelihood of sunburn. Dr. Lim discussed another study comparing users of sun protection factor (SPF) 16 sunscreen with a control group that observed decreased squamous cell carcinoma, basal cell carcinoma, photoaging, and melanoma among the users of sunscreen. Dr. Lim went on to review the public health and environmental detriments of organic filters such as oxybenzone and octinoxate as well as the merits of inorganic (mineral) filters such as zinc oxide and titanium oxide. Dr. Lim finished his presentations with the benefits of photolyases and stabilized, biologically active antioxidants in sunscreens.

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Atopic Dermatitis: Maui Derm 2019 Highlights

Dramatic advances in our understanding of the immunology and pathogenesis of atopic dermatitis (AD) has resulted in the development of new and novel topical and systemic therapies. MauiDerm’s experts discussed new findings regarding the pathogenesis and comorbidities of AD. The spectrum of old and new topical therapies, such as crisaborole, and systemic therapies, including emerging biologic therapies, were discussed.

Andrew Blauvelt, MD

Andrew Blauvelt, MD, MBA, presented attendees with an update on the AD pipeline. Dr. Blauvelt reviewed recent research on biologics such as tralokinumab, an anti-IL-13 monoclonal antibody (mAb), lebrikizumab, an anti-IL-13 mAb, and nemolizumab, an anti-IL-31 receptor A mAb. Dr. Blauvelt discussed other studies on monoclonal antibodies for AD targeting IL-5, IL-22, TSLP, IL-17C, IL-1alpha, IL-33, and OX40.  In addition, Dr. Blauvelt discussed research on the JAK1 Blockers Baricitinib, upadactinib, and PF-04965842. Additional potential therapies discussed include ASN002, ZPL-389, and apremilast. Dr. Blauvelt also covered new topical drugs for AD, including JAK inhibitors, PDE4 inhibitors, and tapinarof.

Eric Simpson, MD, MCR

Eric Simpson, MD, MCR

Eric Simpson, MD, MCR, provided an update on dupilumab. Topics discussed by Dr. Simpson include:

  • When to use systemic therapy
  • What to tell patients to expect with systemic therapy
  • Are there patients who should not be put on dupilumab?
  • Should we check labs?
  • How to treat dupilumab conjunctivitis
  • How to treat facial resistance or flares
  • How long will patients stay on dupilumab?
  • Tapering
  • Other uses for dupilumab
  • Combination treatment
  • Vaccination

Lawrence Eichenfield, MD

Lawrence F. Eichenfield, MD, provided attendees with an update on pediatric AD.

Dr. Eichenfield began by reviewing the typical timeline for AD development and different disease trajectories for the distinct AD phenotypes, noting there is still much work to be done on phenotyping. He went on to review practical recommendations for the evolving therapeutic landscape and the algorithm for incorporating new therapies. Dr. Eichenfield also discussed recent research on topicals for pediatric AD and counseled attendees on an effective approach to infected AD. In addition, topical microbiome transplants and topical bacterial probiotics were discussed. Dr. Eichenfield finished his presentation with other ways to improve care and additional interesting articles from the literature.
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Evaluating and Treating Pruritus: Maui Derm 2019 Highlights

Sonja Ständer, MD

Sonja Ständer, MD

In this session, Sonja Ständer, MD and Gil Yosipovitch, MD, two of the world’s leading authorities on pruritus, discussed the pathophysiology and management of a wide variety of itch disorders.

Topics discussed during the session presentations include:
  • Gil Yosipovitch, MD

    Important questions to ask an itchy patient

  • Simple tools for assessing itch for the dermatologist and allergist
  • Cases of chronic itch without rash
  • Treatment regimen for pruritus of undetermined origin
  • Ending the antihistamine era for atopic dermatitis
  • Addressing the neural system in connection with itch treatment
  • Central nervous system targets for itch treatment by reducing neural sensitization
  • Mature aging itch immunosenescence in the elderly
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