Vallerie McLaughlin, MD, is a professor of medicine and director of the Pulmonary Hypertension Program in the Division of Cardiovascular Medicine at the University of Michigan.

Anjali Vaidya, MD, is the director of the Advanced Pulmonary Hypertension, Right Heart Failure & CTEPH Program and the Pulmonary Hypertension Fellowship at Temple University Hospital and a professor of medicine at Temple University

PAH rarely belongs to a single specialty. The panel describes the team-based model behind effective care and reviews how four complementary treatment pathways now give clinicians a broad toolbox.

PAH Care Teams, Unmet Needs, and the Four Treatment Pathways

This episode, "PAH Care Teams, Unmet Needs, and the Four Treatment Pathways," features the panel examining who belongs on the care team and what the treatment toolbox now contains.

Dr. McLaughlin asks how a multidisciplinary team supports patients with PAH. Dr. Kim explains that pulmonary hypertension does not sit within one subspecialty, so cardiologists and pulmonologists must work together to sort out the cause of shortness of breath. PAH is rare and seldom the first diagnosis considered. Right heart catheterization is required, rheumatologists refer many patients with connective tissue disease, and primary care providers remain essential because patients are living longer and still need general health maintenance.

Dr. McLaughlin adds that no PAH center is complete without nurses, nurse practitioners, and research coordinators, and she says she could not do her job if her nurses left tomorrow. Dr. Channick likens the field to six degrees of Kevin Bacon, since almost any specialty connects to pulmonary hypertension, including hepatology, infectious disease, substance use, and amphetamine-associated disease. Transplant colleagues are sometimes needed as well.

Dr. McLaughlin then asks Dr. Channick about remaining gaps. He says progress breeds impatience, because clinicians can now see what is possible and no longer accept fatalism. The approach is aggressive, optimistic, and proactive, although some patients still do not respond well enough. Dr. McLaughlin recalls that early treatment meant anticoagulants and a box of tissues, whereas today more than a dozen FDA-approved therapies exist.

Dr. Vaidya outlines the four pathways. The nitric oxide pathway includes PDE5 inhibitors and the soluble guanylate cyclase stimulator, the endothelin pathway offers three receptor antagonists, and the prostacyclin pathway spans oral, inhaled, subcutaneous, and intravenous agents. The newest is activin signaling inhibition. The first three are vasodilators with additional antiproliferative effects, and all four work in complementary combinations.

"Initial PAH Therapy: Upfront Dual Oral Combination and Guideline Risk Stratification,"

 Dr. Channick and Dr. Kim review how guidelines and landmark trials support upfront dual therapy.

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Clinical

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Evan Dellon, MD, MPH, is a professor in the division of gastroenterology and hepatology and director of the Center for Esophageal Diseases and Swallowing at UNC School of Medicine.

Joy Chang, MD, MS, is an assistant professor of medicine in the division of gastroenterology at the University of Michigan in Ann Arbor.

This episode, titled ‘Individualizing Initial Treatment Selection in EoE,’ features panelists discussing how they approach the expanding range of therapeutic options available for eosinophilic esophagitis. The experts review proton pump inhibitors, swallowed topical corticosteroids, biologic therapy, dietary elimination, and dilation, emphasizing that treatment selection should reflect both clinical disease features and the patient's preferences and ability to implement a chosen strategy.

Individualizing Initial Treatment Selection in EoE

The panel highlights shared decision-making as a central component of initial therapy. Dietary treatment may appeal to patients who prefer a nonpharmacologic approach, but successful implementation depends on available resources and a patient's willingness to make sustained dietary changes. Similarly, medication options differ in administration requirements and practical burden. Faculty explain that treatment should be followed by objective reassessment, with timing varying by approach. Endoscopy and biopsy remain particularly important because symptom improvement may not accurately reflect inflammatory control.

The experts then discuss when biologic therapy enters the treatment pathway. Inadequate objective response, difficulty sustaining another treatment, and adherence challenges may prompt a change in strategy. Other atopic diseases such as asthma or atopic dermatitis can also influence treatment selection because a biologic may address multiple type 2 inflammatory conditions. The panel emphasizes collaboration with allergy and other specialists, including in settings where formal multidisciplinary clinics are unavailable.

In the next episode, ‘Defining Treatment Goals and Mechanisms in EoE,’ panelists will discuss multidimensional disease-control goals and how topical and systemic therapeutic approaches differ mechanistically.

Effective EoE treatment begins with matching therapy to disease characteristics, patient preferences, and the realities of long-term use. Objective reassessment helps determine when it is time to pivot or escalate.

In ‘Recognizing Progression and Fibrostenotic Disease in EoE,’ our panel explores how misconceptions about who develops eosinophilic esophagitis can contribute to delayed diagnosis and how prolonged disease activity may influence structural progression. The experts challenge the traditional perception of EoE as primarily a disease of young White men, emphasizing that it can occur across ages, sexes, races, and ethnicities. Pediatric patients may also present differently from adults, making a broad clinical index of suspicion important.

Recognizing Progression and Fibrostenotic Disease in EoE

The faculty then examine natural-history data linking longer diagnostic delays with greater prevalence of fibrostenotic disease. They discuss differences in pediatric and adult presentation and explain that increasing duration of untreated disease is associated with greater risk of rings, strictures, and narrowing. The panel defines fibrostenotic disease clinically and describes how these structural changes can impair swallowing and increase the risk for food impaction.

The conversation extends beyond delays before diagnosis to persistent inflammation after EoE has been recognized. Faculty emphasize that continued uncontrolled inflammation can promote scar formation and structural change, providing a rationale for active treatment and objective assessment rather than relying solely on symptoms. They also acknowledge that disease progression is heterogeneous and does not occur identically in every patient. Overall, the experts connect earlier diagnosis, inflammatory control, and individualized escalation with the broader goal of limiting long-term fibrostenotic complications.

Our next episode, ‘Individualizing Initial Treatment Selection in EoE,’ examines how clinicians choose among available therapies and determine when biologic treatment may be appropriate.

EoE can affect patients across demographic groups, and diagnostic delay may carry structural consequences. Earlier recognition and inflammatory control may help reduce progression toward fibrostenotic disease.

Harrison Nguyen, MD, MBA, MPH, is a double board-certified dermatologist/Mohs micrographic surgeon and clinical researcher in Houston, Texas.

Early-career dermatologists moving from academic training into private practice face challenges well outside the scope of clinical medicine. Building a multidisciplinary care team without established referral patterns, protecting time outside the clinic, and understanding reimbursement all shape whether a new practice thrives. Professional self-doubt compounds these pressures, and a research letter in the 

Journal of the American Academy of Dermatology

 examined impostor syndrome among those in the US who are dermatology residents.¹

Hidradenitis suppurativa surgery illustrates the reimbursement problem. Procedural interventions, including deroofing and excision, hold a defined place in the North American clinical management guidelines for hidradenitis suppurativa from the United States and Canadian Hidradenitis Suppurativa Foundations.² Yet the complexity of these operations does not always translate into proportional payment, a gap with direct consequences for dermatologists building surgical hidradenitis suppurativa services.

The Early Career Dermatology Initiative at the 

2026 Fall Clinical Dermatology Conference

 in Las Vegas addressed these issues in a non-CME session titled “Career and Life Practical Tips” on October 10, 2026.³ Faculty included Aaron S. Farberg, MD, Sandra Lee, MD, and Diego Dasilva, MD, among others. Harrison Nguyen, MD, MBA, MPH, managing director of Harrison Dermatology Research Group and clinical assistant professor at Baylor College of Medicine and the University of Houston College of Medicine, sat on the panel.

He spoke on the case for general dermatology during the session’s debate. Below, in this second segment of his Q&A, Nguyen shares his approach to patients who push back, along with the single piece of career advice he left with the audience:

: What tips did you and your fellow panelists highlight during the “Career and Life Practical Tips” session?

It was so fun to be on the early career session at the Fall Clinical conference. I was on that panel with Aaron Farberg, Sandra Lee, aka ‘Dr. Pimple Popper’, Dan Butler, and Diego Dasilva. We talked about some of the challenges you encounter early on in a career as a dermatologist or dermatology clinician, and how to navigate them. We talked about how you navigate the challenging patient in your clinic, and you can think about the challenging patient from different perspectives. One is the complex, challenging patient, the patient with really complex or difficult disease, and how you organize multidisciplinary care, especially in a private practice setting. A lot of us are coming from academics.

Residents especially will often train in an academic setting where you have established referral patterns, but when it comes to private practice, you have to organize your own multidisciplinary care team. So that was one pearl we shared. Then there’s also the challenging patient from, let’s say, the more emotionally or socially challenging side, or the patient who argues back on every topic you bring up, and we talked about different ways to help navigate those patients.

We also talked about work-life balance. That’s a term that’s commonly used, but often it’s really work-life harmonization: how do you integrate both work and life and make them both come together? For me, I suggested scheduling life the same way we schedule things for our work. We scheduled this discussion, you and me, Tim. It’s just as important to schedule life events: dinners with my fiancé, making sure breakfast with the grandparents is scheduled, making sure the vacation with family is scheduled out next year, and protecting it in the same way we protect our professional engagements.

We also talked about billing and coding tips. I talked about HS, and to be aware that HS surgeries often come with a 90-day global period. Especially in my neck of the woods in Texas, we did a single-site analysis of claims, and we found we’re actually reimbursed less for doing these really complex, challenging HS surgeries than for cutting out a simple cyst plus a repair. So I talked to the audience about how to navigate that. Finally, we had a debate between myself and Diego about the pros and cons of super-specialized dermatology versus generalized dermatology. I was tasked with arguing on behalf of the generalized dermatologist, while Diego argued on behalf of the specialized dermatologist; let’s say you’re only doing Mohs, or you’re only specializing in HS. There are certainly pros and cons to that, and we had fun doing it.

: When a patient pushes back on everything, what usually drives it in your experience, and how do you address it?

 It depends on the patient. I think one of the insights is we have to spend a little bit of time with that challenging patient to understand where he or she is coming from and why they’re being combative or defensive. Sometimes it has to do with negative experiences they’ve had at other dermatology practices. Sometimes it has to do with an experience a loved one had with the healthcare system. Sometimes it has to do with an interaction the patient had with your front desk staff that maybe didn’t go as well as it could have. When you see that patient, sometimes you see it before you even hear it. You see it in their body language; you see it in their facial expressions.

It’s important to make sure you take a pause and maybe even sit down. I like to sit down with every patient; I have a stool in the room. We know sitting down at the patient’s level makes patients feel like we’re spending more time with them. So I like to sit down, and then with a patient who has already shown they may be a little defensive, or not easy to get on the same wavelength with, we take the extra couple of moments to communicate that we are there to take care of them, that we’re on the same team, and that we’re here to listen to them as well. We make sure we hear what they’re saying so we can appropriately address it.

: Among the tips shared, which takeaway do you think clinicians are least aware of?

We were also asked to conclude the session with the one tip we wanted to leave the audience with, and the tip I shared is to bet on yourself before you’re ready. The path of medicine often leaves us with imposter syndrome, where we don’t think we’re ready. There’s always this voice inside you making you second-guess yourself. I want our community and early-career dermatologists to bet on themselves before they ever feel ready: to get on the podium before you feel ready, to take that consulting opportunity before you feel ready, and, if you’re interested in starting a practice, to get out there and start making those steps before you ever feel ready. I’ll tell you from personal experience, as someone who has done a lot of those things, you never fully feel ready.

You never fully feel like you have all your ducks in a row, but that’s just how our lives and our careers go. So for those who have aspirations extraclinically, we’re already trained to be good dermatologists, but if you want to pursue other opportunities in your career, maybe launch a social media platform, do it. Bet on yourself and take that chance, because you’ll never look back and say, “Man, I regret taking that chance or that opportunity.” But you may look back and regret not doing it. That was my tip for the audience, and I hope it resonates with our early-career dermatologists: bet on yourself, because no one else will.

Editor’s Note: This transcript has been edited for grammar and clarity using artificial intelligence tools.

Regan PA, Shumaker K, Kirby JS. Impostor syndrome in United States dermatology residents. 

. 2020;83(2):631-633. doi:10.1016/j.jaad.2019.10.018.

Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part I: diagnosis, evaluation, and the use of complementary and procedural management. 

. 2019;81(1):76-90. doi:10.1016/j.jaad.2019.02.067.

Fall Clinical Dermatology Conference. Fall Clinical 2026 attendee agenda. Updated August 21, 2026. Accessed October 26, 2026. 

https://a-us.storyblok.com/f/572562823577716/x/1e5af87c27/fall-clinical-2026-attendee-agenda-v5-08212026.pdf

Articles

This segment of Nguyen's 2026 Fall Clinical Dermatology interview highlights key insights on early dermatology career strategies and other information.

Hidradenitis Suppurativa

Hidradenitis Suppurativa condition center page, audiences can find a variety of coverage mediums for medical news and updates, including articles, video interviews, podcasts, and breaking news on dermatology research, treatment, and drug development.

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Q&A: Early-Career Dermatology Pearls on Defensive Patients and HS Coding

Intermediate- and high-risk status signals a struggling right ventricle and a prognosis the panel considers unacceptable. They argue for treating risk assessment as a routine vital sign while weighing what patients say they want from therapy.

PAH Risk Assessment: Why Reaching Low Risk Matters for Patients

Welcome back to another HCPLive Peer Exchange series. In "PAH Risk Assessment: Why Reaching Low Risk Matters for Patients," moderator Vallerie McLaughlin, MD is joined by Richard Channick, MD, Anjali Vaidya, MD, FACC, FASE, FACP, and Nick H. Kim, MD to open the series on pulmonary arterial hypertension.

Dr. McLaughlin outlines a program that spans guideline-based risk stratification, combination therapy, route of administration, escalation and switching, and newer therapies, then asks Dr. Kim what the treatment burden looks like for patients who have not reached low-risk status. Dr. Kim notes that many patients are diagnosed late and remain symptomatic even on treatment.

He explains that risk assessment combines clinical and laboratory data to gauge the health of the right ventricle, so an intermediate or high-risk label means the right ventricle is still struggling. In his view that status is not acceptable, and the goal is to bring every patient to low risk. He compares risk assessment to a new vital sign, closest to a hemoglobin A1c in this disease, and cites registry data showing hospitalization and mortality above 20% per year in high-risk patients.

Dr. Vaidya adds that patients rarely ask about their risk category and instead say they want to feel better, spend time with family, attend events, and stay out of the hospital. She argues that quality of life and functional capacity matter as much as formal calculations, although validated questionnaires are hard to complete at every visit.

Dr. Channick cautions that risk calculators work best at the population level, because each patient has different variables and needs an individualized assessment. His central message is that patients must be reassessed by whatever method the clinician prefers, and he calls patients who never get reassessed the bigger problem. As treatment options expand, frequent and regular follow-up becomes even more important.

"PAH Care Teams, Unmet Needs, and the Four Treatment Pathways,"

 turns to the multidisciplinary team and Dr. Vaidya's overview of the four treatment pathways.

Podcasts

Brynn Marks, MD, MSHPEd, joins Diana Isaacs, PharmD, and Natalie Bellini, DNP, to discuss a new framework defining fully closed loop insulin delivery.

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This page also hosts content previously published by EndocrinologyNetwork. 


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podcasts page features a feed of medical news and interview podcast series, including DocTalk, Lungcast, Derm Discussions, and Heart Trials.

Diabetes Dialogue

Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives is a podcast hosted by Diana Isaacs, PharmD, and Natalie Bellini, DNP, aimed at providing a regular roundup of the latest clinically applicable insights across diabetes and metabolic diseases, with a focus on leveraging technology to improve care.

Diabetes Dialogue: Building A Consensus Definition for Fully Closed-Loop Systems

Virginia Wang, PhD, MSPH, is a research health scientist with Health Services Research and Development at the Durham VA Health Care System and professor in the Department of Population Health Sciences at Duke University School of Medicine.

A retrospective cohort of 34,398 veterans found similar hospital days in VA and community dialysis settings across pandemic periods.

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

VA Dialysis Tied to Lower Mortality, With Virginia Wang, PhD, MSPH

Reena Mehra, MD, head of the Division of Pulmonary, Critical Care and Sleep Medicine at the University of Washington School of Medicine and holder of the A. Bruce Montgomery, MD, American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine.

In a post hoc analysis of 2 phase 3 trials, AD109 reduced hypoxic burden by 69.8% vs 20.0% with placebo in postmenopausal women with OSA.

Obstructive Sleep Apnea

Sleep

On the HCPLive sleep page, resources on the topics of medical news and expert insight into sleep medicine can be found. Content includes articles, interviews, videos, podcasts, and breaking news on sleep apnea, insomnia, narcolepsy, and more.

Pulmonology

Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

AD109 Cuts AHI by 59.6% in Postmenopausal Women With OSA

Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for 

. He is also the executive producer of two podcasts: 

. 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.

Edaravone dexborneol before thrombectomy improved 90-day independence only in LVO stroke patients with clinical-radiological mismatch in TASTE-2.

Stroke

On the HCPLive stroke page, resources on the topics of medical news and expert insight into CVA can be found. Content includes articles, interviews, videos, podcasts, and breaking news on stroke medicine, and more.

Which LVO Stroke Patients Benefit from Edaravone Dexborneol Before EVT?

Steven D. Nathan, MD, is the director of the Advanced Lung Disease Program and medical director of the lung transplant program at Inova Fairfax Hospital

A TETON-2 post hoc analysis at CHEST 2026 found 126 progression events with inhaled treprostinil vs 161 with placebo across 52 weeks.

Inhaled Treprostinil Reduces Recurrent IPF Events, With Steven Nathan, MD

Alia Galadari, MD, discusses subtle erythema, commonly missed diagnoses, and research gaps to help clinicians recalibrate their approach to skin of color.

Skin of Color Savvy: The Art and Science of Treating Patients of Color

Hosted by Skin of Color Society and produced by HCPLive, 

 delves into the latest research, clinical insights, and culturally intelligent care practices in dermatology with leading experts. 

Whether it’s groundbreaking research, practice-changing insights, or highlights from the SOCS community, this twice-monthly program provides dermatologists and care providers with expert perspectives on treating patients with skin of color.

Skin of Color Savvy: Recalibrating the Clinical Lens in Skin of Color Dermatology

Adriana Marton, MD, of Klinikum Nürnberg in Germany and Duke-NUS Medical School in Singapore

Investigators will probe acid base metabolism and metabolomics to explain the blood pressure and potassium findings from DapaBalci-Leap.

What Drives Balcinrenone’s BP Effect? With Adriana Marton, MD

Balcinrenone lowered systolic BP by 14.1 mm Hg in stage 3 CKD, while combination therapy preserved dapagliflozin's glucosuric effect.

Balcinrenone Plus Dapagliflozin Lowers BP, With Adriana Marton, MD

This Q&A interview segment with Harrison Nguyen, MD, MBA, MPH, highlights key points made during his 2026 Fall Clinical Dermatology meeting sessions.

Atopic Dermatitis

Atopic Dermatitis condition center page, audiences can find a variety of coverage mediums for medical news and updates, including articles, video interviews, podcasts, and breaking news on dermatitis research, treatment, and drug development.

Q&A: Looking Beyond Body Surface Area in Atopic Dermatitis Treatment Selection

Quality of life in IgG4-related disease reflects disease activity, accumulated damage, and treatment burden. The panel explains why no single measure yet captures the full patient experience.

Latest News

PAH Care Teams, Unmet Needs, and the Four Treatment Pathways

Individualizing Initial Treatment Selection in EoE

Recognizing Progression and Fibrostenotic Disease in EoE

Q&A: Early-Career Dermatology Pearls on Defensive Patients and HS Coding

PAH Risk Assessment: Why Reaching Low Risk Matters for Patients