Nada Elbuluk, MD, MSc, is a dermatologist in California. 

Michelle Rodrigues, MBBS, is a dermatologist in Australia.

Practical Approaches to Hyperpigmentation and Hypopigmentation, With Nada Elbuluk, MD, MSc, and Michelle Rodrigues, MBBS

In the second featured clip from the most recent episode of the 

 leaders, Michelle Rodrigues, MBBS, founder and director of Chroma Dermatology, and Nada Elbuluk, MD, MSc, assistant professor at the USC Keck School of Medicine, explore the diagnostic complexity of pigmentary disorders in patients with skin of color, emphasizing the importance of precision, pattern recognition, and patient-centered care.

Their conversation reinforces a key message: pigmentary change is not a diagnosis in itself, but rather a clinical sign with a broad and nuanced differential. Rodrigues opens by noting that terms such as “hyperpigmentation” or “hypopigmentation” are often used too broadly, which can lead to oversimplification and mismanagement. Instead, she emphasizes the need to identify the underlying cause, whether inflammatory, autoimmune, medication-related, or genetic. Elbuluk builds on this point by highlighting how post-inflammatory hyperpigmentation remains one of the most common concerns among patients of color, often arising from acne, eczema, or other inflammatory dermatoses.

While frequently dismissed as cosmetic, both experts stress that pigmentary disorders can have a profound psychosocial impact and deserve thoughtful evaluation and treatment. A significant portion of the discussion focuses on clinical assessment strategies. Rodrigues underscores the value of a careful history and physical examination, paying close attention to lesion distribution, color variation, borders, and evolution over time.

She also highlights dermoscopy as a valuable, noninvasive tool that can help distinguish epidermal from dermal pigment and guide management decisions, potentially reducing the need for biopsy in select cases. Elbuluk adds that understanding a patient’s background—including prior inflammation, treatments, and cultural skin-care practices—is essential to accurate diagnosis.

The conversation also addresses conditions such as vitiligo and acquired dermal macular hyperpigmentation, underscoring how these disorders may present differently across skin tones and how delayed diagnosis can worsen outcomes. Both speakers emphasize the importance of setting realistic expectations with patients, as pigmentary disorders often require prolonged treatment courses and careful maintenance.

Together, Rodrigues and Elbuluk advocate for a more deliberate, informed approach to pigmentary disease—one that recognizes both the biological complexity and emotional weight of these conditions for patients with skin of color.

To learn more about SOCS’s programs and initiatives, visit 

Editor’s note: This summary was edited with the help of AI tools.

Videos

This segment of the latest Skin of Color Savvy episode highlights a conversation between Nada Elbuluk, MD, MSc, and Michelle Rodrigues, MBBS.

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Uncovering Hidden IV Fluid Contamination in CBCs, With Carly Maucione, MD

Carly Maucione, MD, a resident physician at Washington University in St. Louis

Uncovering Hidden IV Fluid Contamination Through Machine Learning, With Carly Maucione, MD

Machine learning may help close the gap in identifying intravenous (IV) fluid contamination in complete blood counts (CBCs) and prevent unnecessary transfusions, according to new research.

The findings from the multicenter study suggest IV fluid contamination in CBCs may be more common than previously recognized, with machine learning models identifying possible contamination in approximately 2% of samples.

“Finding that there is this unmet need, I think, should shock some people, and I think it’s okay to be shocked,” said study investigator Carly Maucione, MD, a resident physician at Washington University in St. Louis, in an interview with 

. “The results were higher than we expected. But there’s mounting evidence that IV fluid contamination is a significant issue, and it’s something we could address in the laboratory.”

Specimen contamination with IV fluids has long been recognized as a challenge in clinical laboratories, as it can produce erroneous CBC results, influencing diagnostic interpretation and clinical decision-making.

As Maucione explained, in inpatient settings, clinicians may encounter unexplained drops in hemoglobin that later normalize, sometimes without a meaningful impact on patient management. In more concerning scenarios, however, falsely low hemoglobin values may prompt unnecessary transfusion decisions.

Still, identifying IV fluid contamination after samples arrive in the laboratory remains difficult. Detection requires laboratory technologists' expertise, with a lack of standardized methods to train pathologists. As such, recognition depends largely on a technologist’s ability to identify abnormal result patterns and infer possible causes. This approach is inherently variable and difficult to scale across high-volume laboratory workflows.

Study investigators recognized machine learning as a potential solution to standardize care and identify IV fluid contamination with precision and accuracy.

To address this gap, investigators conducted a retrospective, multicenter machine learning diagnostic validation study using real-world inpatient data from 2 institutions. The team developed and tested 2 machine learning models designed to retrospectively identify IV fluid contamination in CBC results. Since no gold standard exists for confirming contamination, model outputs were validated against expert chart review.

The models were trained using simulated IV fluid contamination scenarios. They incorporated prior, current, and post-hemoglobin concentrations, platelet counts, and white blood cell counts. Performance was then assessed using 1 year of inpatient CBC data from each institution to evaluate real-world applicability. Transfusions were only classified as potentially unnecessary when post-transfusion hemoglobin values were unexpectedly higher than pre-transfusion values and exceeded 8 g/dL, aligning with commonly used transfusion thresholds.

The models demonstrated strong discriminatory performance, with areas under the receiver operating characteristic curve of 0.972 and 0.957, and areas under the precision-recall curve of 0.723 and 0.619, respectively. Across both institutions, approximately 2% of inpatient CBC trios were classified as potentially contaminated, as previously mentioned.

Importantly, the investigators evaluated the clinical implications associated with contaminated results. Among inpatient transfusions for which a CBC trio was available, investigators deemed 6%-9% potentially unnecessary based on a conservative, rule-based definition validated through expert chart review.

“We are seeing that there are clinical consequences, and those clinical consequences are things that we can track using an algorithm such as this one,” said Maucione. “Both of those are things that we think are worth addressing and moving forward in either developing similar algorithms to detect this prospectively, using these as measures in order to track these rates.”

Maucione C, McLamb N, Zaydman MA, Pearson LN, Metcalf RA, Spies NC. Identification of IV fluid contamination in complete blood counts and subsequent unnecessary red blood cell transfusions using artificial intelligence. 

. Published online August 2026:10.1111/trf.70072. doi:https://doi.org/10.1111/trf.70072

Newbigging A, Landry N, Brun M, et al. New solutions to old problems: A practical approach to identify samples with intravenous fluid contamination in clinical laboratories. 

. 2024;127-128:110763. doi:https://doi.org/10.1016/j.clinbiochem.2024.110763

Machine models identified 2% of CBCs as possibly contaminated and flagged 6–9% of inpatient transfusions as potentially unnecessary, explains Maucione. 


Hematology

Ozan Unlu, MD, is a fellow in interventional cardiology at Brigham and Women’s Hospital and Harvard University.

Home Blood Pressure Monitoring Engagement Suboptimal Among Most Patients, With Ozan Unlu, MD

Patient engagement with home blood pressure monitoring (HBPM) is suboptimal despite widespread awareness of 

 risk, presenting a barrier to effective treatment and demanding innovative approaches to the HBPM process.

A recent cohort study, conducted within a remote hypertension management program at Mass General Brigham, collected and analyzed data on adults with uncontrolled hypertension between 2018 and 2022. The investigators sought to determine the degree of patient engagement with HBPM, given the 12-measurements-per-week guidelines for reliable assessment. Ultimately, they found a significant proportion of the study population exhibited no engagement whatsoever.

“The implications of this are important. It doesn’t mean that the guidelines really need to change, to recommend fewer blood pressure measurements, because the guideline recommendations are well grounded in research,” Ozan Unlu, MD, a fellow in interventional cardiology at Brigham and Women’s Hospital and lead investigator on the study, told 

 in an exclusive interview. “However, I think we need to come up with ways to understand why patients are not measuring their blood pressures and then mitigate this.”

During the program, patients received a free, validated HBPM device that automatically transmitted readings to the clinic. Additionally, education and support from health care navigators was provided. Patients were identified via Mass General Brigham’s electronic health record based on hypertensive office blood pressure, which was defined as the most recent office systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg on ≥2 occasions.

After enrollment, patients were entered into a 7-day baseline measurement period. Patients took blood pressure measurements at home twice each morning and evening before medications on ≥6 days per week; investigators were aiming for 24-28 weekly readings. A minimum of 12 readings over 3 days was required to ensure a reliable baseline measurement. Confirmed hypertension led to a series of 14-day medication titration cycles, each of which included a 7-day waiting period post-medication initiation or dose change. This model was continued until maintenance, defined as reaching target BP average (<130/80 mmHg) was achieved over 7 days.

This cohort analysis included a total of 3390 patients, with a median age of 61 (interquartile range [IQR], 52-69) years. A high proportion of patients had comorbidities, such as 

 (n = 996). At baseline, 1107 patients had no engagement with HBPM, 484 had low engagement, 618 had medium engagement, and 1181 had high engagement. This translates to 1591 patients with insufficient measurements. The median number of blood pressure measurements per patient per week was 16 (IQR, 0-26) for baseline assessment.

These findings indicate that, even with the support of automatic data transmission, frequent reminders, and clinical education via a large-scale program at an integrated academic medical center, engagement with HBPM was suboptimal. Almost half of the included patients recorded <12 measurements, which were required to continue into the program’s active titration phase. Only about 1 in 3 patients achieved the 24-28 measurements per week recommended by the program.

“In general, whenever we recommend some lifestyle changes to our patients, it requires a behavior change,” Unlu told 

. “And that’s not always easier to do. I think blood pressure measurements are just a few minutes in a day, but for patients, it requires some kind of behavior change to have that habit into their daily routine. That’s not always possible, if their daily routine doesn’t allow them to do that.”

Editor’s Note: Unlu reports no relevant disclosures.

Unlu O, Zelle D, Cannon CP, et al. Patient Engagement With Home Blood Pressure Monitoring. 

Blood AJ, Cannon CP, Gordon WJ, et al. Results of a Remotely Delivered Hypertension and Lipid Program in More Than 10 000 Patients Across a Diverse Health Care Network. JAMA Cardiol. 2023;8(1):12-21. 

Despite being considered superior to in-clinic measurements, a substantial number of patients do not follow the HBPM guideline recommendations of 12 readings per week.

Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

Hypertension

The HCPLive hypertension page is a resource for medical news and expert insights on high blood pressure. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for hypertension, and more.

Nancy Reau, MD, is Professor of Internal Medicine, Richard B. Capps Chair of Hepatology, Associate Director of Solid Organ Transplantation, and Section Chief of Hepatology at Rush University Medical Center.

Understanding Missed HCC Screening in Patients With Cirrhosis: Barriers to Care

Surveillance for hepatocellular carcinoma (HCC) in patients with cirrhosis is a cornerstone of liver care, yet real-world adherence to screening remains a persistent challenge. In this segment of Liver Lineup: Updates & Unfiltered Insights, hosts Kim Brown, MD, and Nancy Reau, MD, examine new data on how wide the gap remains between guideline recommendations and clinical practice as well as why that gap exists.

Check out the full episode on advances in liver transplantation and hepatocellular carcinoma 

Brown introduced a prospective, 3-year cohort study of adults with cirrhosis that evaluated adherence to HCC surveillance, along with patient-reported reasons for nonadherence. She explained that the investigators excluded individuals with pre-existing liver lesions or incomplete data and defined full adherence as receiving both ultrasound imaging and alpha-fetoprotein (AFP) testing every 6 months. Brown highlighted how low adherence truly was: fewer than 10% of patients met criteria for full adherence, while even partial adherence, defined as ultrasound alone, remained below 50%.

She emphasized that the reasons for nonadherence were multifactorial, the most striking being that more than a quarter of patients reported that surveillance had not been recommended by their treating physician. Brown described this as particularly disappointing given the well-established association between routine surveillance and earlier tumor detection. She suggested that this gap may be especially relevant in patients with metabolic disease, where clinicians may not consistently recognize cirrhosis-related cancer risk.

Reau expanded on these findings by highlighting practical challenges that arise in everyday clinical care. She noted that the study did not specify how many patients received AFP testing alone, an important omission given how surveillance is often implemented in practice.

Drawing from her own experience, Reau described how patients may resist blood draws, imaging studies, or both. She also pointed to frustrations around ultrasound quality, including inadequate visualization and the frequent need for follow-up imaging, which can lead to patient fatigue and disengagement.

Reau further emphasized that evolving guidelines have added complexity, particularly surrounding AFP, which has long been a point of debate. She pointed out that not all clinicians may be fully aware of updated recommendations re-incorporating it into routine surveillance, complicating how adherence is defined and measured.

Brown closed the discussion by returning to the issue of access and feasibility. While lack of physician recommendation was the leading barrier, resource limitations and geographic access were also significant. She underscored growing interest in blood-based screening strategies, noting that emerging data presented at The Liver Meeting may offer more practical, scalable approaches to HCC surveillance in the future, especially for patients who struggle to access imaging.

Editors’ note: Relevant Disclosures for Reau include AbbVie, Gilead, Salix, Arbutus, and VIR. Relevant disclosures for Brown include Mallinckrodt Pharmaceuticals, Gilead, Salix, Intercept, Ipsen, and Madrigal.

Shukla A, Padole V, Vaidya A. NON-ADHERENCE TO SURVEILLANCE PROTOCOL OF HEPATOCELLULAR CANCER IN PATIENTS WITH LIVER CIRRHOSIS: PREVALENCE AND REASONS. Presented at the American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025. Washington, DC. November 7-11, 2025.

This segment of Liver Lineup features an in-depth discussion on hepatocellular carcinoma screening in patients with cirrhosis.

Hepatology

Tim Pflederer, MD, is the chief medical officer at Evergreen Nephrology

Guiding CKD Care Through Updated Dietary Guidelines, With Tim Pflederer, MD

In response to the recently released federal Dietary Guidelines for Americans, 2025–2030, nephrologists should ensure patients with impaired kidney function, 

) are following individualized, treatment-informed diets.

The US Department of Health & Human Services (HHS) released the updated guidelines on January 7, 2026, emphasizing high-quality protein, healthy fats, fruits, vegetables, and whole grains while discouraging highly processed foods and refined carbohydrates.

“I think the direction of [the guidelines] is right and good for kidney disease, but at the same time, there are nuanced messages that our patients need to hear related to those guidelines,” Tim Pflederer, MD, shared in an interview with 

Patients with renal impairment have reduced glomerular filtration rate (GFR), which limits the kidney’s ability to excrete potassium, phosphorus, and nitrogenous waste from protein metabolism. 

Excess protein, particularly from animal sources

, can increase renal solute load, stimulate hyperfiltration in residual nephrons, and accelerate CKD progression, as Pflederer highlighted in a previous discussion with our team.

Consequently, intake of high-potassium foods and protein must be carefully managed, with attention to laboratory monitoring, CKD stage, and dialysis schedules.

While the guidelines encourage more whole vegetables and fruits, clinicians should encourage their patients with kidney disease to carefully select options. Many common fruits and vegetables are high in potassium, Pflederer explained, including bananas, oranges, potatoes, tomatoes, avocados, and dried fruits.

Hyperkalemia occurs when serum potassium rises above safe physiologic levels, which can trigger cardiac arrhythmias and sudden death. In patients with advanced CKD or ESKD, impaired renal excretion makes them particularly vulnerable. Patients on dialysis rely on the treatment to remove extra potassium, so dietary intake must be carefully adjusted based on the timing of treatments between sessions.

“If they're having difficulty with potassium, they should talk to their physician to make certain that the foods that they're eating that are whole, fresh fruits and vegetables, particularly, are not high in potassium,” said Pflederer.

Clinicians can offer options with regulated levels of potassium, including apples, berries, grapes, white rice, white bread, and fresh white meat. Additionally, cooking methods such as boiling or leaching may reduce potassium content, which may help patients manage intake more safely.

The guidelines also encourage avoidance of processed foods, which Pflederer acknowledges can benefit kidney health. Many processed products contain phosphorus additives, which are almost completely absorbed and can accumulate quickly in patients with reduced kidney function, increasing the risk of mineral imbalances and long-term complications.

In patients with CKD, impaired kidney function reduces phosphate excretion, which can trigger increases in fibroblast growth factor 23 (FGF23) and parathyroid hormone (PTH). Over time, this can weaken bones and cause calcium to deposit in blood vessels and organs, increasing the risk of heart attack, stroke, and other complications.

“Eliminating processed foods will at the same time be overall good for their health, and eliminate and reduce the phosphorus burden that is difficult for people with kidney disease to handle,” said Pflederer.

Editor’s Note: Pflederer reports no relevant disclosures. 

Fact Sheet: Trump Administration Resets U.S. Nutrition Policy, Puts Real Food Back at the Center of Health. HHS.gov. Published January 7, 2026. 

https://www.hhs.gov/press-room/fact-sheet-historic-reset-federal-nutrition-policy.html

Ko GJ, Kalantar-Zadeh K. How important is dietary management in chronic kidney disease progression? A role for low protein diets. 

‌Potassium and Chronic Kidney Disease - DaVita | DaVita. DaVita. Published June 20, 2025. 

https://davita.com/diet-nutrition/articles/potassium-and-chronic-kidney-disease/

Six Steps to Controlling High Potassium. National Kidney Foundation. Published August 12, 2024. 

https://www.kidney.org/news-stories/six-steps-to-controlling-high-potassium‌

‌National Kidney Foundation. Phosphorus and Your CKD Diet. National Kidney Foundation. Published June 26, 2025. 

https://www.kidney.org/kidney-topics/phosphorus-and-your-ckd-diet

Russo D, Battaglia Y. Clinical Significance of FGF-23 in Patients with CKD. 

Tim Pflederer, explains how nephrologists can help patients with CKD and ESKD navigate the 2025–2030 Dietary Guidelines, including managing protein, potassium, and phosphorus intake.

Nephrology

The HCPLive nephrology page is a resource for medical news and expert insights on kidney disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in nephrology, and more.

Chronic Kidney Disease

Diana Isaacs, PharmD, is an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic.

This segment of Diabetes Dialogue spotlights the FDA clearance of the MiniMed Go and its collaborative capacity with various other devices.

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Integrating Every Facet of Insulin Delivery With Medtronic’s MiniMed Go

Michael E. Thase, MD, of the University of Pennsylvania

Adjunctive lumateperone 42 mg improves remission, relieves anxiety and sleep symptoms, and shows sustained safety in patients with treatment-resistant MDD.

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Lumateperone Shows Broad Symptom Benefit for MDD, With Michael E. Thase, MD

Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for HCPLive. He is also the executive producer of two podcasts: Skin of Color Savvy and The Medical Sisterhood. Previously, he was the producer of the Lungcast podcast. He graduated from UC Berkeley and worked in multimedia journalism as a staff writer prior to joining MJH. You can contact him at tsmith@mjhlifesciences.com.

Articles

This survey highlights several key findings related to patient concerns and caregiver concerns over topical steroids (TCS).

Plaque Psoriasis

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Topical Steroid Concerns in Dermatology Highlighted in Nationwide Survey

Sayna Norouzi, MD, is an assistant professor of medicine, clinical nephrologist, and founder and director of the glomerular disease and polycystic kidney disease clinics at Loma Linda University Medical Center.

In the closing discussion, the panel looks ahead to how IgA nephropathy treatment may continue to evolve.

Video Series

Future Directions in IgAN

Courtney Balentine, MD, MPH, is an associate professor in the department of surgery at the University of Wisconsin School of Medicine and Public Health and director of the Wisconsin Surgical Outcomes Research Program.

Balentine explains the unique challenges of AI implementation in surgery and reviews his research on current barriers to real-world uptake.

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Bringing AI to the OR: Real-World Challenges And What’s Next, With Courtney Balentine, MD, MPH

Updated federal guidelines highlight protein intake, with Tim Pflederer emphasizing the importance of individualized nutrition strategies for CKD patients


New Federal Dietary Guidelines Impact on Chronic Kidney Disease Management, With Tim Pflederer, MD

Andrew Vissing, MD, an attending physician and assistant professor at Northwestern University Feinberg School of Medicine.

Andrew Vissing shares his clinical perspective and strategies to mitigate gaps in care and management for young adults with glomerular disease.


IgA Nephropathy

The HCPLive Berger disease page is a resource for medical news and expert insights on IgA nephropathy. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in Berger disease, and more.

Focal Segmental Glomerulosclerosis

The HCPLive focal segmental glomerulosclerosis page is a resource for medical news and expert insights on FSGS. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in FSGS, and more. 

Implementing Age-Specific Care For Young Adults With Glomerular Disease With Andrew Vissing, MD

Victoria Johnson joined the MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and now HCPLive. You can reach her at vjohnson@mjhlifesciences.com

New guidelines on biologic management for severe asthma provide essential recommendations for optimizing treatment choices among clinicians.

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New CHEST Recommendations Guide Biologic Use for Severe Asthma

This segment of the most recent episode of Skin of Color Savvy highlights a conversation between Shawn Kwatra, MD, and Andrew Alexis, MD, MPH.

Improving Recognition of Skin Disease in Diverse Skin Types, With Shawn Kwatra, MD, and Andrew Alexis, MD, MPH

In a 26-week study, adjunctive seltorexant showed no average weight gain in obese patients with MDD and insomnia unlike quetiapine, according to data presented at ACNP 2026.


Obesity Management

Obesity Management condition center page, resources on the topics of medical news and expert insight into clinical weight management can be found. Content includes articles, interviews, videos, podcasts, and breaking news on obesity research, treatment, and drug development.

Latest News

Practical Approaches to Hyperpigmentation and Hypopigmentation, With Nada Elbuluk, MD, MSc, and Michelle Rodrigues, MBBS

Uncovering Hidden IV Fluid Contamination Through Machine Learning, With Carly Maucione, MD

Home Blood Pressure Monitoring Engagement Suboptimal Among Most Patients, With Ozan Unlu, MD

Understanding Missed HCC Screening in Patients With Cirrhosis: Barriers to Care

Guiding CKD Care Through Updated Dietary Guidelines, With Tim Pflederer, MD