In this video blog, Peter Lio, MD, discusses highlights from his lecture Challenging Inflammatory Cases on July 25, 2024, during the inaugural Elevate-Derm Alliance Summer Conference at the Westin Copley Place in Boston, Massachusetts.

In this video

Speaking with Jennifer Conner, Dr. Lio walks through several of the trickiest inflammatory presentations from his session. Aerosolized allergic contact dermatitis, he notes, "breaks the rules" — unlike the slam-dunk case under a band-aid or belt buckle, it can look like almost anything because the allergen is in the air. He recounts an older patient with stubborn facial flares that resolved only after they discovered she was walking past a mall perfume counter on her commute. On vitamin D, he acknowledges the literature is "all over the place" but recommends 4,000 IU daily for most adults, reasoning it is inexpensive, likely low in most patients given modern life, and rarely associated with hypervitaminosis D.

Much of the conversation centers on topical steroid withdrawal syndrome, for which Dr. Lio describes distinctive findings like the "sleeve sign," "elephant wrinkles," and a proposed new term, "arderma" — from the Latin for burned or ashes — to capture the widespread exfoliative appearance he sees in patients who don't fit atopic dermatitis. He is working with the CDC toward an ICD-10 code so the entity can be studied. His approach starts with listening to and respecting patients, then offers three paths: narrowband UVB phototherapy, dupilumab, and cyclosporine. He also points patients to the National Eczema Association's free EczemaWise app as an empowering, educational resource.

  • Suspect aerosolized allergic contact dermatitis when conventional therapy fails and lesions don't follow the localized, geometric pattern — take a thorough history of weekend and environmental exposures.
  • Consider 4,000 IU/day of oral vitamin D for most adult atopic dermatitis patients; it's inexpensive, generally safe, and hypervitaminosis D is rare, so watch for signs rather than blanket-testing.
  • Watch for TSW-specific findings like the "sleeve sign," "elephant skin," and widespread exfoliation Dr. Lio proposes calling "arderma" — presentations that fall outside textbook atopic dermatitis.
  • For presumptive topical steroid withdrawal, practice good steroid stewardship and offer three options: narrowband UVB, dupilumab, or cyclosporine (all off-label, since the FDA doesn't yet recognize the entity).
  • Direct patients to the National Eczema Association's free EczemaWise app (eczemawise.org) for tracking, journaling triggers, and reminding them they're not alone.