George Martin, MD, a dermatologist at the Dermatology and Laser Center of Maui and the co-founder of Scholars in Medicine and Maui Dermatology.

George Martin, MD

HCPLive Five: Maui Derm NP+PA Summer 2026

, held in Colorado Springs from June 24 to 27, brought together leading dermatologists to address diagnostic and treatment updates across numerous 

, including eczematous dermatitis, rosacea, autoimmune blistering disease, hair loss, and pigmentation disorders. From IL-13 inhibitor response as a patch testing gatekeeper to the expanding oral JAK inhibitor pipeline in vitiligo, this year's sessions reflected how targeted therapies are reshaping diagnostic sequencing across dermatology subspecialties.

 Nickel and ammonium persulfate are the most missed patch test allergens

 Ocular involvement in up to 50% of patients

 Suspect pemphigoid in patients > 65 years with treatment-resistant pruritus

 3 oral JAK inhibitors FDA-approved for severe alopecia areata

 Vitiligo affects up to 1% of population, half before age 20 years

rounds up 5 key takeaways NPs and PAs can apply in practice.

Eczematous Dermatitis: IL-13 Inhibitor Response Guides Patch Testing Decisions

Matthew Zirwas, MD, of Bexley Dermatology, discussed how IL-13 inhibitor response now guides patch testing decisions in eczematous dermatitis. He starts with a detailed history of product and exposure changes, then trials dupilumab or lebrikizumab across 6 weeks and 3 doses before considering patch testing. Nonresponse or worsening signals likely contact dermatitis warranting testing.

Zirwas identified nickel and ammonium persulfate as the 2 most missed allergens, noting dietary nickel can drive systemic contact dermatitis and ammonium persulfate exposure often stems from hot tub chemicals, both frequently excluded from standard patch testing.

Rosacea Staging: From Pediatric Erythema to Phymatous Disease

Hilary Baldwin, MD, from Atantla Health, used a single composite patient to trace rosacea from pediatric erythema through adult flushing, papulopustular disease, and late-stage phymatous and ocular involvement, matching treatment to each stage. Pediatric rosacea, affecting 4% or fewer children, is often missed because red cheeks appear benign. Background erythema responds to alpha agonists, flushing requires oral carvedilol or botulinum toxin, and telangiectasias need energy-based treatment. Papulopustular disease is the most treatable, with ivermectin, topical minocycline, and newer sub-antimicrobial oral options like Emrosi. Ocular rosacea responds to tetracyclines and topical ivermectin.

Pemphigus, Pemphigoid: Diagnosing Atypical Blistering Disease Presentations

Donna Culton, MD, PhD, of UNC School of Medicine, addressed atypical presentations of autoimmune blistering diseases. Pemphigus often presents with chronic oral ulcers rather than classic flaccid blisters, while pemphigoid may have a prodromal phase resembling urticaria or eczematous dermatitis. Culton advised suspecting non-bullous pemphigoid in patients > 65 years with pruritic disease unresponsive to first-line treatment. She cautioned that serology can be falsely negative, particularly in anti-p200 pemphigoid, and that perilesional biopsy is essential for direct immunofluorescence. Following dupilumab's 2025 FDA approval for bullous pemphigoid, NPs and PAs can initiate treatment earlier, reserving referral for treatment failure or diagnostic uncertainty.

Hair Loss Treatment: JAK Inhibitors and Oral Minoxidil Reshape Care

Benjamin Ungar, MD, of Mount Sinai's Alopecia Center of Excellence, called JAK inhibitors the biggest advance in hair loss treatment over the past 2 years, reshaping care for alopecia areata and scarring alopecia. 3 oral JAK inhibitors, baricitinib, ritlecitinib, and deuruxolitinib, are FDA-approved for severe AA, and Ungar's long-term data show no meaningful increase in cardiovascular or thromboembolic risk despite class-wide boxed warnings. He favors oral JAK inhibitors as first-line systemic therapy over traditional immunosuppressants. Low-dose oral minoxidil is increasingly used across hair loss subtypes, with hypertrichosis as the most common side effect. Ungar views nutraceuticals as adjunctive, useful mainly for patients with underlying nutrient deficiencies.

Vitiligo, Melasma: Pigmentation Treatment Pipeline Advances

George Martin, MD, of the Dermatology and Laser Center of Maui, reviewed advances in vitiligo and melasma treatment. Topical ruxolitinib remains the only FDA-approved topical vitiligo therapy, showing durable, increasing repigmentation through 2 to 3 years of treatment, though extensive disease above 50% body surface area requires additional systemic therapy. Oral JAK inhibitors, including povorcitinib, ritlecitinib, and upadacitinib, are advancing in additional late-stage trials and are expected to replace pulse-dose dexamethasone for widespread active disease.

For melasma, Martin emphasized combining lightening topicals with procedural treatment, noting current sunscreens inadequately block visible light despite its role in pigmentation.

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5 dermatology takeaways from Maui Derm NP+PA Summer 2026, covering eczematous dermatitis, rosacea, blistering disease, hair loss, and pigmentation disorders.

Melasma Treatment Advances, With George Martin, MD

 treatment for 75 years, but George Martin, MD, a dermatologist at the Dermatology and Laser Center of Maui and the co-founder of Scholars in Medicine and Maui Dermatology, told 

 that the field is entering a period of meaningful change. During his session on disorders of pigmentation at 

in Colorado Springs, Martin walked through where hydroquinone still fits, which newer agents are gaining traction, and why he considers oral tranexamic acid the most underutilized tool in the melasma armamentarium.

Hydroquinone Remains a Mainstay, but Alternatives Are Expanding

Martin noted that hydroquinone is most effective when combined with fluocinolone and tretinoin in a triple combination cream, a regimen he continues to consider the mainstay of melasma treatment. For patients who cannot tolerate hydroquinone or wish to avoid it, he pointed to over-the-counter topical cysteamine as an established option. He also highlighted topical thiamidol as a newer bleaching agent that he described as more powerful than hydroquinone.

Additional options entering the space include compounded and commercially available topical metformin and topical tranexamic acid-containing serums. Martin said these additions to the melasma toolkit are an encouraging sign for patients who have not responded to conventional therapy.

Oral Tranexamic Acid: An Underused Option

Martin identified oral tranexamic acid as the most powerful and underutilized therapy currently available for melasma. Originally used to inhibit bleeding, the plasmin inhibitor and antifibrinolytic agent is effective at reducing hyperpigmentation and melanin production, a mechanism Martin tied to its antifibrinolytic activity. The drug is also used in operating rooms to control hemorrhage during procedures such as those in obstetrics and gynecology.

Because of its association with clotting risk, Martin emphasized the need for careful patient selection before initiating therapy. He said the effective dose range identified over time is 500 mg per day, typically divided into 250 mg twice daily, and noted that oral tranexamic acid can be used alongside topical bleaching agents. This dosing aligns with published literature, in which a network meta-analysis found 250 mg 3 times daily for 12 weeks to be the optimal dose, though 250 mg twice daily may be an acceptable alternative for patients with adherence concerns.²

Martin discussed chemical peels, microneedling, and energy-based devices as adjuncts for patients who do not respond to topical and oral therapy. He cautioned that deeper peels carry greater risk of worsening hyperpigmentation, calling the practice “more art than science” and one that requires experience.

Before escalating to procedures, Martin said he evaluates whether patients are practicing effective photoprotection. He noted that visible light, which current sunscreens do not block, is a significant driver of hyperpigmentation, and adequate visible light protection is not yet available but is anticipated soon. Patients who are already using effective photoprotection and oral tranexamic acid without improvement are the ones he considers candidates for procedural intervention.

Acquired Dermal Macular Hyperpigmentation

Martin also addressed acquired dermal macular hyperpigmentation, a unifying term he described for a group of conditions that includes lichen planus pigmentosus, Riehl melanosis, and erythema dyschromicum perstans. He noted that although these conditions have traditionally been treated as distinct entities, they share overlapping histopathology and a common underlying pathogenesis, prompting efforts to consolidate them under one diagnostic framework.

“I think that the introduction of new bleaching agents, such as thiamidal and others, are really exciting to add to our armamentarium, which includes the mainstay of hydroquinone in the form of a triple therapy,” Martin concluded. “Our topical and peeling agents are fantastic adjuncts to the therapy and can help move the needle, but the biggest problem we face in hyperpigmentation of the skin is photoprotection, and hopefully in the next year or so we're going to see effective visible light blockers.”

Watch part 1 of the interview with Martin, where he discusses 

Editor’s note: Reported disclosures for Martin include AbbVie, Pfizer, Novartis Pharmaceuticals, Janssen Biotech, ER Squibb & Sons, Incyte Corporation, Organon, Galderma Laboratories, Genzyme Corporation, Amgen, LEO Pharma, UCB, Arcutis Biotherapeutics, Almirall, Biofrontera, Sun Pharmaceutical Industries, Lilly USA, and more.

Martin G. Disorders of Pigmentation. Session presented at Maui Derm NP+PA Summer 2026 in Colorado Springs.

Wang WJ, Wu TY, Tu YK, et al. The optimal dose of oral tranexamic acid in melasma: a network meta-analysis. 

https://pubmed.ncbi.nlm.nih.gov/36332095/

Pigmentation pipeline: vitiligo and melasma treatment advances. HCPLive. Published July 10, 2026. 

https://www.hcplive.com/view/pigmentation-pipeline-vitiligo-melasma-treatment

Martin discussed where hydroquinone still fits, why oral tranexamic acid remains underused, and how he decides when to escalate to procedural therapy.

Pigmentation Pipeline: Vitiligo and Melasma Treatment Advances

 has moved from an underserved disease to one of dermatology's most active treatment areas, according to George Martin, MD, who discussed disorders of pigmentation at 

 Martin, a dermatologist at the Dermatology and Laser Center of Maui and the cofounder of Scholars in Medicine and Maui Dermatology, structured his session around 2 categories: depigmentation disorders like vitiligo and hyperpigmentation disorders like melasma.

Vitiligo affects up to 1% of the population, and about half of cases begin before the age of 20 years.

, Martin noted the disease carries a genetic association and was long considered an orphan condition before targeted therapies arrived.

Topical Ruxolitinib Shows Durable, Growing Benefit

Topical ruxolitinib, a JAK1/2 inhibitor, remains the 

only FDA-approved topical therapy for vitiligo

 Martin said its effect does not plateau. Patients continue to show increasing repigmentation 2 and 3 years into treatment, a pattern he described as "the gift that keeps on giving."

The therapy's main limitation is body surface area. Martin said patients with more extensive involvement, generally above 50% body surface area, need systemic options layered on top of topical treatment.

Several oral Janus kinase (JAK) inhibitors are advancing through late-stage trials for vitiligo. Martin pointed to povorcitinib (a JAK1 inhibitor) and ritlecitinib (a JAK3/TEC inhibitor) as therapies positioned to expand systemic options.

 AbbVie announced topline phase 3 results of upadacitinib for vitiligo in October 2025.

Martin said these therapies will likely replace the current standard approach for widespread, active vitiligo: pulse-dose dexamethasone given twice weekly, often combined with narrowband UV-B phototherapy. He cited an algorithm developed by John Harris, MD, PhD, now chair at Massachusetts General Hospital, as a framework many clinicians already follow for turning off active disease before starting repigmentation therapy.

Not every practice has in-office narrow band UV-B, Martin said, which pushes many clinicians toward topical and systemic regimens by default. He expects ruxolitinib to increasingly replace topical steroids in combination protocols, both for its efficacy and its safety profile.

Melasma Treatment Requires a Combined Approach

On the hyperpigmentation side, Martin focused on melasma, which he called one of the most common disorders clinicians see in daily practice. He said effective treatment requires combining skin-lightening topicals with procedures such as peels and lasers, rather than relying on a single modality.

Martin said that photoprotection remains equally important, but current sunscreens fall short. A recent consensus statement on visible light, led by Henry Lim, MD, established the need to block visible light in addition to UVA and UV-B.

“Sadly, all of our current sunscreens are ineffective at blocking visible light and require some combination of iron oxides or some other visible blocking molecules,” Martin said. “There is some really good science out there to show that we're now capable of blocking visible light, but this combination of minerals has not yet been commercialized.”

Editor’s note: Reported disclosures for Martin include AbbVie, Almirall, Amgen, Arcutis Biotherapeutics, Biofrontera, ER Squibb & Sons, Galderma Laboratories, Genzyme Corporation, Incyte Corporation, Janssen Biotech, LEO Pharma, Lilly USA, Novartis Pharmaceuticals, Organon, Pfizer, Sun Pharmaceutical Industries, UCB, and more.

Martin G. Disorders of pigmentation. Presented at: Maui Derm NP+PA Summer. June 24-27, 2026; Colorado Springs, CO.

Vitiligo facts. Global Vitiligo Foundation. Accessed July 9, 2026. 

https://globalvitiligofoundation.org/vitiligo-facts/

Vitiligo. Yale Medicine. Accessed July 9, 2026. 

https://www.yalemedicine.org/conditions/vitiligo

Butera A. FDA Approves ruxolitinib cream 1.5% for nonsegmental vitiligo. HCPLive. July 18, 2022. Accessed on July 9, 2026. 

https://www.hcplive.com/view/fda-approves-ruxolitinib-cream-for-nonsegmental-vitiligo

Smith T. HCPLive. Oral povorcitinib for extensive nonsegmental vitiligo yields positive results in phase 2b trial. October 11, 2023. Accessed July 9, 2026. 

https://www.hcplive.com/view/oral-povorcitinib-extensive-nonsegmental-vitiligo-positive-results-phase-2b-trial

Smith T. HCPLive. Ritlecitinib efficacious for non-segmental vitiligo across various subgroups. January 15, 2026. Accessed July 9, 2026. 

https://www.hcplive.com/view/ritlecitinib-efficacious-non-segmental-vitiligo-across-various-subgroups

AbbVie announces positive topline results from phase 3 pivotal studies evaluating upadacitinib (Rinvoq) in adults and adolescents with vitiligo. AbbVie. October 29, 2025. Accessed July 9, 2026. 

https://news.abbvie.com/2025-10-29-AbbVie-Announces-Positive-Topline-Results-from-Phase-3-Pivotal-Studies-Evaluating-Upadacitinib-RINVOQ-R-in-Adults-and-Adolescents-with-Vitiligo

Lim HW, Schalka S, Trautinger F, et al. International modified Delphi consensus statement on visible light photoprotection: Effects, measurement, and recommendations. 

Topical ruxolitinib shows sustained repigmentation over years, while oral JAK inhibitors move toward approval for widespread disease, George Martin, MD, says.

George Martin, MD

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