Adam Friedman, MD, FAAD

Dermatology Education Foundation (DERM) 2025 NP/PA CME Conference

, Adam Friedman, MD, from the George Washington University School of Medicine & Health Sciences Department of Dermatology, spoke about off-label approaches to therapeutic challenges in conditions such as lichen planus.

 about the lack of US Food and Drug Administration (FDA)-approved treatments for lichen planus and other lichenoid dermatitides, advocating for off-label use of JAK inhibitors and other treatments like oral retinoids and doxycycline. He also highlighted the potential of JAK inhibitors in autoimmune skin disease treatment, noting conditions such as cutaneous lupus, dermatomyositis, and morphia, noting ongoing clinical studies and personal successes.

Off-Label Approaches to Therapeutic Challenges in Dermatology, with Adam Friedman, MD

“Now, none of these diseases I mentioned have anything meant for them, so that's where we get to be ‘off-label bandits’ and be quite creative,” Friedman said. “I have found with tinkering and trying out different things that in my hands, JAK inhibitors have been the most effective. But historically, the go-tos were things like oral retinoids for moderate to severe disease; most notably, acitretin has the most evidence supporting its use. I've also, for oral lichen planus, low-dose doxycycline. It makes sense because if you think about the initial indication for doxycycline, 20 milligrams, twice a day, which was for chronic gingivitis, I can guarantee you that some of those patients had oral lichen planus, and it just wasn't distinguished. So I think that there are some low-hanging fruit, whether it be topical agents, …whether it be low-dose antibiotics, oral retinoids, or even immunosuppressants. But I think the age of JAK inhibitors in the utilization for lichenoid dermatitis is upon us.”

For dermatomyositis, Friedman emphasized the importance of malignancy screening. In morphia, he highlighted the need for physical therapy to prevent joint deformity. Overall, Friedman encouraged creativity and vigilance for new treatments to improve patient care.

View his full video interview posted above to find out more about these topics. For more from DERM2025, view the latest conference coverage.

The quotes used in this interview summary were edited for clarity.

Friedman has previously reported serving as a consultant to Dermira, Eli Lilly and Company, Encore Dermatology Inc, Exeltis, Galderma, IntraDerm, Johnson and Johnson, Oculus Innovative Sciences, Pfizer Inc, and Sanovaworks.

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In this DERM2025 interview, Friedman highlighted some of the discussion points from his presentation on off-label strategies for therapeutic challenges.

In a new interview conducted on-site at the 

, Adam Friedman, MD, spoke with the HCPLive editorial team about managing tinea, also known as 

Friedman, who serves as Professor, Chair of Dermatology, Residency Program Director, Director of Translational Research, and Director of the Supportive Oncodermatology Program in the George Washington University School of Medicine & Health, emphasized the importance of recognizing and treating dermatophytosis, a common but often overlooked group of fungal skin infections, due to the risk of anti-fungal resistance.

Tips on Managing Patients with Fungal Skin Infections, with Adam Friedman, MD

“Dermatophytosis, which encompasses a wide array of clinical cutaneous infections associated with dermatophyte infections, is super common, but is not commonly discussed because it just isn't ‘sexy,’” Friedman said. “And I get it, who wants to talk about fungal infections? But we can't put our heads in the sand. We need to be able to make the right diagnosis, but also consider the potential for anti-fungal resistance if we don't treat the right thing, or if we're not thoughtful about how we use our anti-fungals, of which we unfortunately don't have a huge amount.”

Friedman stressed that clinical inspection alone is insufficient for diagnosis, advocating for the use of potassium hydroxide preps, scrapings, cultures, and biopsies to accurately identify and treat fungal infections.

“I know we pride ourselves as master diagnosticians, but we have proven time and again in the published literature that clinical inspection is not enough,” Friedman explained. “Use my favorite tool of all time, your potassium hydroxide prep. I realize there are some limitations with CLIA certification, but this very simple tool can be the distinguisher between calling something a dermatophyte infection or something primary inflammatory. By defining the disease, you can purposely select the correct treatment regimen, which will then make your patient happy and will prevent fungi from developing resistance to the limited things we have.”

Friedman went on to warn about of the growing resistance to antifungals, particularly azole anti-fungals like econazole and fluconazole. He noted the necessity for careful anti-fungal stewardship, similar to antibacterial stewardship, given the limited number of new anti-fungal treatments available.

“When we think about our anti-fungal armamentarium, most of them are what are called static,” Friedman said. “They are inhibiting an enzyme or something that's needed for cell survival. And when you are inhibiting one thing, the problem is, the fungus among us can become kind of clever and pivot. That, in essence, is where resistance occurs, where one surviving cell has managed to shift the narrative and utilize other machinery to survive. And then it passes that information through its friends…and then we have an anti-fungal that's rendered useless.”

To find out additional information on the subjects covered by Friedman in his session on tinea, view his full video interview posted above. For more on related information, view our 

The quotes contained in this interview description were edited for clarity.

In this interview, Friedman highlights notable points from his DERM 2025 talk on managing patients with tinea.

One of the most difficult struggles many patients with dermatologic diseases face over the course of their condition is chronic pruritus, also known as itch. This topic was covered in a session at the 

Addressing chronic pruritus and managing this symptom of disease was highlighted in a new 

 interview with Adam Friedman, MD, who serves as Professor, Chair of Dermatology, Residency Program Director, Director of Translational Research, and Director of the Supportive Oncodermatology Program in the George Washington University School of Medicine & Health’s Department of Dermatology.

Discussing Strategies to Manage Chronic Itch Among Patients, with Adam Friedman, MD

“I think one of the greatest struggles when it comes to managing a patient with pruritus, which, you have to understand, can be a symptom or a disease unto itself,” Friedman said. “Is it an itch that rashes, meaning you are manipulating the skin by scratching and now create visible change, or is a rash that itches a primary skin disease that is pruritic? That single question will veer you off into 2 very different directions. I would argue a rash that itches is probably a little easier to manage, because there are a plethora of possible things that can be driving the itch with no obvious primary cutaneous issue. With that in mind, you want an organized approach in order to figure out what could be driving disease.”

Friedman spoke about some of the initial focus of labwork, including checking on issues with the liver, kidneys, and thyroid. He went on to discuss pruritus as a potential presenting sign of different forms of malignancy.

“A chest X-ray I would certainly recommend in the right setting,” Friedman explained. “That is definitely one of the key takeaways: do not forget, pruritus can be a presenting sign of many different flavors of malignancy. Probably the best known would be lymphoma, and that's where the chest X-ray comes in. Other key things not to miss know that bullous pemphigoid can just present as pruritus. Anywhere from 10 to 15% of patients can have no skin findings. Also, you never want to be humbled by scabies.”

Friedman later went on to describe tips regarding treatment options for patients suffering from chronic itch.

“We do have OTC and prescription options that are available to us,” Friedman said. “Probably the hottest thing out there is going to be your topical JAK inhibitors and PDE4 inhibitors, both of which have a unique influence on sensory neurons. Systemically, the take-home is that you should take a little from Aisle A, take a little from Aisle B, meaning go after neuropathic or nerve targeting therapies like SSRIs, gabapentinoids, in combination with anti-inflammatories. If it is a mixed picture, fortunately, we have some really amazing systemic agents that are meant to address inflammation but also will hit itch. I mentioned JAK inhibitors before, but we have a litany of biologics that target key cytokines or receptors that drive both inflammation and sensitization of those neurons. So be creative. Ask lots of questions.”

For any additional information on the topics covered by Friedman in his session, view the full video segment posted above this summary. For more, view our 

The quotes used in this interview description were edited for clarity.

This interview with Friedman highlights the takeaways from his DERM 2025 session on managing chronic pruritus in dermatology.

Top Clinical Insights from SDPA 2025: Eczema, Alopecia, Burnout, Vitiligo, JAK Inhibitors

In late June, physician assistants convened at the 

SDPA Annual Summer Dermatology Conference

 in Washington, DC, from June 25 – June 29th, to attend talks from other physician assistants and clinicians.

in people of color. This edition of HCPLive Five spotlights interviews on tips for treating chronic hand eczema, using trichoscopy to differentiate alopecia subtypes, preventing career burnout, breaking down vitiligo misconceptions, and the workup before initiating JAK inhibitors for alopecia.

Tips to Optimize Diagnosis, Management of Chronic Hand Eczema with Adam Friedman, MD

Adam Friedman, MD, professor, chair of dermatology, and director of the Supportive Oncodermatology Program at The George Washington University School of Medicine & Health Sciences, shared clinical insights on diagnosing and managing chronic hand eczema (CHE), emphasizing its diagnostic complexity. CHE has symptoms that overlap with conditions, such as psoriasis, lichen planus, and secondary syphilis. In his interview, Friedman underscored the importance of patient history, especially recurrence, duration, and occupational exposure, and highlighted visual cues to differentiate CHE from other dermatoses.

He also noted that CHE often lacks sharp demarcation, unlike palmoplantar psoriasis, which favors pressure-prone areas. Recognizing patterns like lichenification and confluence helps inform diagnosis.

Trichoscopy Provides Clearer Differentiation of Alopecia Subtypes, With Amy Spizuoco, DO, FAOCD

Amy Spizuoco, DO, FAOCD, a board-certified dermatologist at True Dermatology and a clinical instructor at Mount Sinai, highlighted how trichoscopy enhances diagnostic accuracy in alopecia by revealing key patterns such as black dots, yellow dots, exclamation hairs, and follicular loss. She explained that recognizing these visual cues, like exclamation hairs in alopecia areata or follicular plugging in telogen effluvium, can distinguish scarring from non-scarring forms and guide proper treatment.

Discussing Ways to Help Clinicians Facing Career Burnout, with Hope Cook, PA-C

Hope Cook, PA-C, a physician associate from Georgia Skin Cancer & Aesthetic Dermatology, shared strategies for addressing clinician burnout, emphasizing that burnout is not the end—it can mark a new beginning.

In her session and interview, she introduced her CPR framework: Cocooning (inner reflection and awareness), Planning (evaluating what needs to change), and Revamping or Resigning (deciding whether to reshape or leave one’s role). Using a controlled burn metaphor, Cook illustrated how burnout can clear space for growth and career renewal. Drawing from her book (“Healing Clinician Burnout: How to Revive Your Life and Career”) and podcast, she offered practical, realistic steps clinicians can take to move from feeling stuck to rediscovering purpose in their professional lives.

Breaking Down Vitiligo Misconceptions at SDPA 2025, With Gina Mangin, PA-C

Gina Mangin, MPAS, PA-C, from Sand Lake Dermatology Center, addressed common vitiligo misconceptions, underlining that treatment is possible, even after years of the disease. In an interview, she highlighted the importance of using a Wood’s lamp to confirm diagnosis, especially in patients with skin of color.

Mangin discussed when to escalate to systemic therapy, using markers like rapid progression, confetti depigmentation, and inflammatory borders to assess disease activity. She also said harder-to-treat areas like hands and feet may require both topicals and phototherapy. With new therapies emerging alongside narrowband UVB, Mangin shared her optimism about re-pigmentation and maintaining results through an aggressive, tailored approach.

The Workup Before Initiating a JAK Inhibitor for Alopecia, With David Cotter, MD, PhD

David Cotter, MD, PhD, an assistant clinical professor at the University of Nevada, outlined key steps in evaluating patients with alopecia areata before starting a JAK inhibitor. His recommended workup includes a CMP, fasting lipids, TB and hepatitis B screening, QuantiFERON gold, and often varicella zoster titers—even beyond guideline recommendations—to assess shingles risk. He also considers pregnancy and HIV testing when appropriate.

Cotter stressed that clinicians should feel confident prescribing JAK inhibitors, as long as baseline labs are clear. Follow-up labs are crucial at 12 weeks, with frequency adjusted by patient risk. While many patients see significant regrowth, safety monitoring remains essential throughout treatment.

Check out insights from SDPA 2025 on eczema, alopecia, vitiligo, burnout, and JAK inhibitor workups—key tips to improve dermatology care.

Adam Friedman, MD, FAAD

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